Healthcare Provider Details

I. General information

NPI: 1730731365
Provider Name (Legal Business Name): KENOVA HEALTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2019
Last Update Date: 08/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 HARDEE RD
KINSTON NC
28504-3320
US

IV. Provider business mailing address

815 HARDEE RD
KINSTON NC
28504-3320
US

V. Phone/Fax

Practice location:
  • Phone: 252-717-4074
  • Fax: 252-522-9154
Mailing address:
  • Phone: 252-717-4074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. KENDRICK BRITTON
Title or Position: DIRECTOR
Credential:
Phone: 252-717-4074