Healthcare Provider Details

I. General information

NPI: 1255007233
Provider Name (Legal Business Name): KJ HOMECARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2021
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3851 CAVANAUGH RD
DAYTON OH
45405-2143
US

IV. Provider business mailing address

3851 CAVANAUGH RD
DAYTON OH
45405-2143
US

V. Phone/Fax

Practice location:
  • Phone: 937-813-3133
  • Fax: 937-813-8223
Mailing address:
  • Phone: 937-813-3133
  • Fax: 937-813-8223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

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