Healthcare Provider Details

I. General information

NPI: 1023542131
Provider Name (Legal Business Name): CHELSEA GLADYS KENDRICK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2017
Last Update Date: 08/16/2021
Certification Date: 08/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 SE 49TH DR
GAINESVILLE FL
32641-1921
US

IV. Provider business mailing address

PO BOX 5193
GAINESVILLE FL
32627-5193
US

V. Phone/Fax

Practice location:
  • Phone: 352-283-1638
  • Fax:
Mailing address:
  • Phone: 352-226-9496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: