Healthcare Provider Details

I. General information

NPI: 1215653068
Provider Name (Legal Business Name): RICHARD KENDRICK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2022
Last Update Date: 10/13/2022
Certification Date: 10/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 N CHAMPION AVE
COLUMBUS OH
43203-1146
US

IV. Provider business mailing address

545 N CHAMPION AVE
COLUMBUS OH
43203-1146
US

V. Phone/Fax

Practice location:
  • Phone: 614-595-7246
  • Fax: 614-427-0523
Mailing address:
  • Phone: 614-595-7246
  • Fax: 614-427-0523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: