Healthcare Provider Details

I. General information

NPI: 1467042838
Provider Name (Legal Business Name): TKM ENTERPRISES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2021
Last Update Date: 01/20/2021
Certification Date: 01/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 N MAIN ST STE 2
BEAVER DAM KY
42320-1915
US

IV. Provider business mailing address

PO BOX 621
HARTFORD KY
42347-0621
US

V. Phone/Fax

Practice location:
  • Phone: 270-977-4663
  • Fax: 270-640-0197
Mailing address:
  • Phone: 270-256-7494
  • Fax: 270-640-0197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: TRENTON KYLE MARTIN
Title or Position: MANAGER
Credential:
Phone: 270-256-7494