Healthcare Provider Details

I. General information

NPI: 1407237241
Provider Name (Legal Business Name): KEMP HOME SERVICE AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2015
Last Update Date: 12/14/2019
Certification Date: 12/14/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5461 SOUTHWYCK BLVD STE 1A
TOLEDO OH
43614-1535
US

IV. Provider business mailing address

5461 SOUTHWYCK BLVD STE 1A
TOLEDO OH
43614-1535
US

V. Phone/Fax

Practice location:
  • Phone: 567-742-7322
  • Fax: 567-742-7366
Mailing address:
  • Phone: 567-742-7322
  • Fax: 567-742-7366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: TAMIKA D KEMP
Title or Position: CEO/OWNER
Credential:
Phone: 567-742-7322