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NPI Code Detail

MEDICARE: KENNEDY COLE

MEDICARE: KENNEDY COLE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
13747P1801XPersonal Care Attendant
2251E00000XHome Health AgencyNV

General Provider Information

NPI Number : 1255800553
Entity Type Code : Individual
Provider Name (Legal Business Name) : KENNEDY COLE
Provider Business Mailing Address
First Line : 1517 SANTA ROSALIA DR
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89031-1010
Country : US
Telephone Number : 702-929-3297
Fax Number : 702-750-9927
Provider Business Practice Location Address
First Line : 1517 SANTA ROSALIA DR
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89031-1010
Country : US
Telephone Number : 702-929-3297
Fax Number : 702-750-9927
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/15/2018
Last Update Date : 11/30/2020

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Directions to “ KENNEDY COLE ” Practice Location

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