Healthcare Provider Details

I. General information

NPI: 1528296654
Provider Name (Legal Business Name): KELLA HOMES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2009
Last Update Date: 06/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27153 SW 134TH CT
HOMESTEAD FL
33032-7782
US

IV. Provider business mailing address

27153 SW 134TH CT
HOMESTEAD FL
33032-7782
US

V. Phone/Fax

Practice location:
  • Phone: 786-752-0235
  • Fax: 786-206-3815
Mailing address:
  • Phone: 786-752-0235
  • Fax: 786-206-3815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number691670896
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code374700000X
TaxonomyTechnician
License NumberEMT300255
License Number StateFL

VIII. Authorized Official

Name: MR. MICHEL GONZALEZ
Title or Position: PRESIDENT
Credential:
Phone: 786-752-0235