Healthcare Provider Details

I. General information

NPI: 1073377859
Provider Name (Legal Business Name): KJ HOMECARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2024
Last Update Date: 02/12/2024
Certification Date: 02/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 ELIZABETH PL
DAYTON OH
45417-3445
US

IV. Provider business mailing address

3851 CAVANAUGH RD
DAYTON OH
45405-2143
US

V. Phone/Fax

Practice location:
  • Phone: 937-813-3133
  • Fax:
Mailing address:
  • Phone: 937-813-3133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279P4000X
TaxonomyPatient Transport Registered Respiratory Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number State

VIII. Authorized Official

Name: LAQUADA CASEY
Title or Position: OWNER
Credential:
Phone: 937-813-3133