DataLabs
datalabs.health made in the usa
DataLabs Facebook Wall   Like   Follow DataLabs on Twitter   Tweet  
Contact us Sign in |  Documentation | 
NPI Code Detail

MEDICARE: KENNETH BOLTZ

MEDICARE: KENNETH BOLTZ
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 AttendantWV

General Provider Information

NPI Number : 1619804754
Entity Type Code : Individual
Provider Name (Legal Business Name) : KENNETH BOLTZ
Provider Business Mailing Address
First Line : 5512 BIG TYLER RD
Second Line :
City : CROSS LANES
State : WV
Zip : 25313-1304
Country : US
Telephone Number : 304-766-9830
Fax Number :
Provider Business Practice Location Address
First Line : 5512 BIG TYLER RD
Second Line :
City : CROSS LANES
State : WV
Zip : 25313-1304
Country : US
Telephone Number : 304-766-9830
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/05/2026
Last Update Date : 05/05/2026

Similar Medicare Providers

1417886987 — ZAIAH TOWNSEND
Practice Location Address:
5512 BIG TYLER RD
CROSS LANES, WV
25313-1304
Practice Phone: 304-766-9830
Practice Fax:
1477483436 — SAMARA ADAMS
Practice Location Address:
5512 BIG TYLER RD
CROSS LANES, WV
25313-1304
Practice Phone: 304-766-9830
Practice Fax:
1093642134 — CATRINA REDMAN
Practice Location Address:
5512 BIG TYLER RD
CROSS LANES, WV
25313-1304
Practice Phone: 304-766-9830
Practice Fax: 304-766-9830
1538671896 — SOUTHERN HOME CARE SERVICES, INC.
Practice Location Address:
5512 BIG TYLER RD
CROSS LANES, WV
25313-1304
Practice Phone: 304-766-9830
Practice Fax:
1750995825 — CRYSTAL LYNN ROSS
Practice Location Address:
5512 BIG TYLER RD
CROSS LANES, WV
25313-1304
Practice Phone: 304-766-9830
Practice Fax:
1174193700 — RICHARD DAVIS
Practice Location Address:
5512 BIG TYLER RD
CROSS LANES, WV
25313-1304
Practice Phone: 304-766-9830
Practice Fax:

Directions to “ KENNETH BOLTZ ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.