Healthcare Provider Details

I. General information

NPI: 1679334106
Provider Name (Legal Business Name): KMF CARE GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2024
Last Update Date: 01/22/2024
Certification Date: 01/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8728 N 39TH AVE
PHOENIX AZ
85051-3712
US

IV. Provider business mailing address

8728 N 39TH AVE
PHOENIX AZ
85051-3712
US

V. Phone/Fax

Practice location:
  • Phone: 402-955-9166
  • Fax:
Mailing address:
  • Phone: 402-955-9166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State

VIII. Authorized Official

Name: MRS. LILLIAN CHONCLAY
Title or Position: CEO
Credential:
Phone: 402-955-9166