Healthcare Provider Details

I. General information

NPI: 1578073235
Provider Name (Legal Business Name): KUAN ENTERPRISES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2017
Last Update Date: 04/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7774 118TH ST
JACKSONVILLE FL
32244-3404
US

IV. Provider business mailing address

7774 118TH ST
JACKSONVILLE FL
32244-3404
US

V. Phone/Fax

Practice location:
  • Phone: 561-531-8997
  • Fax: 904-212-2147
Mailing address:
  • Phone: 561-531-8997
  • Fax: 904-212-2147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: SIXTO JESUS NOVATON
Title or Position: PRESIDENT
Credential:
Phone: 561-531-8997