Healthcare Provider Details

I. General information

NPI: 1346866456
Provider Name (Legal Business Name): KINSEYS IV RESOURCES, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2020
Last Update Date: 07/04/2020
Certification Date: 07/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 10TH ST STE 1
LAKE PARK FL
33403-3167
US

IV. Provider business mailing address

300 10TH ST STE 1
LAKE PARK FL
33403-3167
US

V. Phone/Fax

Practice location:
  • Phone: 561-247-7920
  • Fax: 561-247-7929
Mailing address:
  • Phone: 561-247-7920
  • Fax: 561-247-7929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. GINA C KINSEY
Title or Position: OWNER
Credential: RN
Phone: 561-247-7920