MEDICARE: KENOSA DEALINGS INC

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
1	253Z00000X	In Home Supportive Care Agency	194700197	CA

General Provider Information

NPI Number	:	1487104642
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KENOSA DEALINGS INC

Provider Business Mailing Address
First Line	:	18565 SOLEDAD CANYON RD
Second Line	:
City	:	CANYON COUNTRY
State	:	CA
Zip	:	91351-3700
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	18565 SOLEDAD CANYON RD
Second Line	:
City	:	CANYON COUNTRY
State	:	CA
Zip	:	91351-3700
Country	:	US
Telephone Number	:	661-993-7299
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SAMUEL OMOREGIE
Credential	:
Telephone Number	:	661-993-7299

Provider Enumeration Date	:	10/11/2016
Last Update Date	:	10/11/2016

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