=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477119188
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KIND LOYAL SERVICE RN HEALTHCARE SERVICES PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/17/2019
-----------------------------------------------------
Last Update Date | 08/04/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 173 HUGUENOT ST STE 200
-----------------------------------------------------
City | NEW ROCHELLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10801-7710
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-661-3797
-----------------------------------------------------
Fax | 914-661-3797
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 173 HUGUENOT ST STE 200
-----------------------------------------------------
City | NEW ROCHELLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10801-7710
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-661-3797
-----------------------------------------------------
Fax | 914-732-9885
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR/ADMINISTRATOR
-----------------------------------------------------
Name | PATRICE NATTALIE JOHNSON
-----------------------------------------------------
Credential | REGISTERED NURSE
-----------------------------------------------------
Telephone | 914-316-1598
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------