Healthcare Provider Details

I. General information

NPI: 1558733865
Provider Name (Legal Business Name): KHIRO KREATIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2015
Last Update Date: 10/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6511 RUNNINGWOODS DR
TAMPA FL
33634-4721
US

IV. Provider business mailing address

1002B S CHURCH AVE #18412
TAMPA FL
33679-9001
US

V. Phone/Fax

Practice location:
  • Phone: 813-352-5764
  • Fax:
Mailing address:
  • Phone: 813-362-1236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: GLENDA JOYCE PINKNEY
Title or Position: OWNER
Credential:
Phone: 813-362-1236