Healthcare Provider Details

I. General information

NPI: 1538996285
Provider Name (Legal Business Name): KASI CARR ENTERPRISES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2024
Last Update Date: 09/17/2024
Certification Date: 09/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11140 NW 35TH ST
SUNRISE FL
33351-7507
US

IV. Provider business mailing address

7860 WEST COMMERCIAL BOULEVARD SUITE 200 #729
LAUDERHILL FL
33351
US

V. Phone/Fax

Practice location:
  • Phone: 954-649-2056
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name: KASSANDRA CARR
Title or Position: FOUNDER
Credential: CPA, CHWC, CD
Phone: 954-649-2056