Healthcare Provider Details

I. General information

NPI: 1982518643
Provider Name (Legal Business Name): KINSHIP PACE OF MIAMI-DADE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

662 E 27TH ST
HIALEAH FL
33013-3638
US

IV. Provider business mailing address

225 CROSSWAYS PARK DR
WOODBURY NY
11797-2083
US

V. Phone/Fax

Practice location:
  • Phone: 317-493-7608
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251T00000X
TaxonomyPACE Provider Organization
License Number
License Number StateNULL

VIII. Authorized Official

Name: RYAN LEAHY
Title or Position: CFO
Credential:
Phone: 845-235-6531