Healthcare Provider Details

I. General information

NPI: 1962312934
Provider Name (Legal Business Name): KINYAANI HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

OLD WEST MESA SUNSET DRIVE HOUSE 8
CROWNPOINT NM
87313
US

IV. Provider business mailing address

PO BOX 1591
CROWNPOINT NM
87313-1591
US

V. Phone/Fax

Practice location:
  • Phone: 505-210-4881
  • Fax:
Mailing address:
  • Phone: 505-210-4881
  • 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: MRS. GWENDOLYN J GOODLUCK
Title or Position: OWNER/ADMINISTRATOR
Credential:
Phone: 505-210-4881