Healthcare Provider Details

I. General information

NPI: 1598902397
Provider Name (Legal Business Name): KEN-CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2009
Last Update Date: 01/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 NE 10TH AVE SUITE 10
GAINESVILLE FL
32601-2300
US

IV. Provider business mailing address

102 NE 10TH AVE SUITE 10
GAINESVILLE FL
32601-2300
US

V. Phone/Fax

Practice location:
  • Phone: 352-373-9233
  • Fax: 352-379-9530
Mailing address:
  • Phone: 352-373-9233
  • Fax: 352-379-9530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHCS228096
License Number StateFL

VIII. Authorized Official

Name: MR. KEN HARDEN
Title or Position: CEO
Credential:
Phone: 352-373-9233