Healthcare Provider Details

I. General information

NPI: 1922603109
Provider Name (Legal Business Name): K&CL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2020
Last Update Date: 12/03/2020
Certification Date: 12/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 KILN CREEK PKWY STE H
NEWPORT NEWS VA
23602-9700
US

IV. Provider business mailing address

1405 KILN CREEK PKWY STE H
NEWPORT NEWS VA
23602-9700
US

V. Phone/Fax

Practice location:
  • Phone: 757-234-7372
  • Fax: 757-234-7072
Mailing address:
  • Phone: 757-234-7372
  • Fax: 757-234-7072

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 Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: KAYLENE LANDERS
Title or Position: OWNER/ADMINISTRATOR
Credential: RN
Phone: 757-234-7372