Healthcare Provider Details

I. General information

NPI: 1255278107
Provider Name (Legal Business Name): KC LANZ INDUSTRIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3120 SAINT PETERS CHURCH RD
WALDORF MD
20601-2327
US

IV. Provider business mailing address

3120 SAINT PETERS CHURCH RD
WALDORF MD
20601-2327
US

V. Phone/Fax

Practice location:
  • Phone: 443-810-0633
  • Fax:
Mailing address:
  • Phone: 443-810-0633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: DEANGELA HAMILTON
Title or Position: OWNER
Credential:
Phone: 443-810-0633