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General NPI Number Information
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NPI Number | 1588953384
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Entity Type | Organization
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Legal Business Name | KELLA HOMES
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Dates
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Enumeration Date | 04/01/2011
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Last Update Date | 04/01/2011
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Provider Practice Location Address
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Address Line | 19 OCEANA AVE
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City | KEY LARGO
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State | FL
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Zip | 33037-4706
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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 | 19 OCEANA DR
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City | KEY LARGO
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State | FL
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Zip | 33037-4706
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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 | PRESSIDENT
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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 | 385HR2060X
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Taxonomy Name | Child Intellectual and/or Developmental Disabilities Respite Care
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License Number | 003174600
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License Number State | FL
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