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General NPI Number Information
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NPI Number | 1265749865
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Entity Type | Organization
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Legal Business Name | TINA L. KENNEDY
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Dates
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Enumeration Date | 09/03/2010
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Last Update Date | 09/03/2010
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Provider Practice Location Address
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Address Line | 128 W BIGELOW ST
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City | UPPER SANDSKY
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State | OH
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Zip | 43351-1128
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Country | US
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Telephone | 419-209-9031
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Fax |
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Provider Business Mailing Address
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Address Line | 128 W BIGELOW ST
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City | UPPER SANDSKY
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State | OH
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Zip | 43351-1128
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Country | US
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Telephone | 419-209-9031
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Fax |
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Authorized Official
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Title or Position | LPN
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Name | MRS. TINA L KENNEDY
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Credential |
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Telephone | 419-209-9031
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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