Healthcare Provider Details

I. General information

NPI: 1780186031
Provider Name (Legal Business Name): KWB COMPANION SERVICES, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2018
Last Update Date: 03/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4575 NW 160TH ST
REDDICK FL
32686-3383
US

IV. Provider business mailing address

4575 NW 160TH ST
REDDICK FL
32686-3383
US

V. Phone/Fax

Practice location:
  • Phone: 352-239-7705
  • Fax:
Mailing address:
  • Phone: 352-239-7705
  • Fax:

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: MS. KAYLA MARTIN
Title or Position: OWNER
Credential:
Phone: 352-239-7705