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General NPI Number Information
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NPI Number | 1528296654
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Entity Type | Organization
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Legal Business Name | KELLA HOMES LLC
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Dates
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Enumeration Date | 06/26/2009
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Last Update Date | 06/28/2013
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Provider Practice Location Address
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Address Line | 27153 SW 134TH CT
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City | HOMESTEAD
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State | FL
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Zip | 33032-7782
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Country | US
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Telephone | 786-752-0235
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Fax | 786-206-3815
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Provider Business Mailing Address
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Address Line | 27153 SW 134TH CT
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City | HOMESTEAD
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State | FL
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Zip | 33032-7782
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Country | US
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Telephone | 786-752-0235
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Fax | 786-206-3815
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. MICHEL GONZALEZ
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Credential |
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Telephone | 786-752-0235
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374700000X
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Taxonomy Name | Technician
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License Number | EMT300255
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number | 691670896
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License Number State | FL
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