Healthcare Provider Details

I. General information

NPI: 1376471649
Provider Name (Legal Business Name): KMY HOME CARE AGENCY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2026
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2805 HOAGLAND AVE
FORT WAYNE IN
46807-1430
US

IV. Provider business mailing address

2805 HOAGLAND AVE
FORT WAYNE IN
46807-1430
US

V. Phone/Fax

Practice location:
  • Phone: 260-385-7592
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: KAY FAI YA
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 260-385-7592