Healthcare Provider Details

I. General information

NPI: 1205061397
Provider Name (Legal Business Name): KENCREST SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2009
Last Update Date: 05/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960A HARVEST DR SUITE 100
BLUE BELL PA
19422-1900
US

IV. Provider business mailing address

960A HARVEST DR SUITE 100
BLUE BELL PA
19422-1900
US

V. Phone/Fax

Practice location:
  • Phone: 610-825-9360
  • Fax: 610-825-4127
Mailing address:
  • Phone: 610-825-9360
  • Fax: 610-825-4127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: TONIA MCNEAL
Title or Position: CFO
Credential:
Phone: 610-825-9360