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General NPI Number Information
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NPI Number | 1275994022
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Entity Type | Organization
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Legal Business Name | KENNEDY'S ASSISTIVE LIVING AND EDUCATIONAL FACILTY
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Dates
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Enumeration Date | 03/08/2016
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Last Update Date | 03/08/2016
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Provider Practice Location Address
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Address Line | 1941 DECKER BLVD
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City | COLUMBIA
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State | SC
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Zip | 29206-3470
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Country | US
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Telephone | 803-787-0020
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Fax |
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Provider Business Mailing Address
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Address Line | 1941 DECKER BLVD
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City | COLUMBIA
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State | SC
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Zip | 29206-3470
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Country | US
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Telephone | 803-787-0020
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | DR. CAROLYN A KENNEDY
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Credential | ED.D.
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Telephone | 803-736-5872
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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Taxonomy #2
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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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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | 2016-38336-37480
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License Number State |
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Taxonomy #6
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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Taxonomy #7
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Taxonomy Code | 251300000X
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Taxonomy Name | Local Education Agency (LEA)
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License Number |
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License Number State |
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