Healthcare Provider Details

I. General information

NPI: 1376463091
Provider Name (Legal Business Name): KJC SHS HOLDINGS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5260 SE BURNING TREE CIR
STUART FL
34997-8031
US

IV. Provider business mailing address

5260 SE BURNING TREE CIR
STUART FL
34997-8031
US

V. Phone/Fax

Practice location:
  • Phone: 313-949-8110
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: MR. THOMAS CICONTE
Title or Position: OWNER
Credential:
Phone: 313-949-8110