Healthcare Provider Details

I. General information

NPI: 1013730126
Provider Name (Legal Business Name): KHEN & RACHAMIN HEALTH SERVANT'S, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2024
Last Update Date: 11/06/2024
Certification Date: 11/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12822 EARLY RUN LN
RIVERVIEW FL
33578-3376
US

IV. Provider business mailing address

12822 EARLY RUN LN
RIVERVIEW FL
33578-3376
US

V. Phone/Fax

Practice location:
  • Phone: 813-404-3807
  • Fax:
Mailing address:
  • Phone: 813-404-3807
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: BEVERLY JUNE EUBANKS
Title or Position: OWNER
Credential: RN
Phone: 813-404-3807