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General NPI Number Information
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NPI Number | 1447482609
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Entity Type | Organization
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Legal Business Name | KENNEDY'S ASSISTIVE LIVING & EDUCATIONAL FACILITY
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Dates
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Enumeration Date | 08/20/2009
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Last Update Date | 02/26/2010
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Provider Practice Location Address
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Address Line | 3031 SCOTSMAN RD STE 13
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City | COLUMBIA
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State | SC
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Zip | 29223-1812
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Country | US
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Telephone | 803-736-5872
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Fax | 803-736-5872
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Provider Business Mailing Address
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Address Line | 3031 SCOTSMAN RD STE 13
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City | COLUMBIA
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State | SC
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Zip | 29223-1812
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CAROLYN ANN KENNEDY
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Credential |
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Telephone | 803-736-9151
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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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 | 332BN1400X
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Taxonomy Name | Nursing Facility Supplies (DME)
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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 | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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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 | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number | 2009-38336-37480
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License Number State | SC
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