Healthcare Provider Details

I. General information

NPI: 1063399285
Provider Name (Legal Business Name): KENMARK HOME CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2025
Last Update Date: 08/21/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 E MCKINLEY AVE
MISHAWAKA IN
46545-6210
US

IV. Provider business mailing address

411 E MCKINLEY AVE
MISHAWAKA IN
46545-6210
US

V. Phone/Fax

Practice location:
  • Phone: 574-217-7598
  • Fax: 574-217-7752
Mailing address:
  • Phone: 574-217-7598
  • Fax: 574-217-7752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH GACHACHA
Title or Position: NURSE
Credential: RN
Phone: 574-217-7598