Healthcare Provider Details

I. General information

NPI: 1003588666
Provider Name (Legal Business Name): KEN CARE SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2021
Last Update Date: 02/11/2022
Certification Date: 02/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5740 SHERIDAN ST
HOLLYWOOD FL
33021-3251
US

IV. Provider business mailing address

5740 SHERIDAN ST
HOLLYWOOD FL
33021-3251
US

V. Phone/Fax

Practice location:
  • Phone: 754-221-0107
  • Fax: 954-874-8005
Mailing address:
  • Phone: 754-221-0107
  • Fax: 954-874-8005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: JONES OLOWONIYI
Title or Position: ADMINISTRATOR
Credential:
Phone: 754-221-0107