=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598351801
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KENDRICK KARE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/21/2020
-----------------------------------------------------
Last Update Date | 12/21/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6396 MCLEOD DR STE 6
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89120-4429
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 754-308-4067
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6396 MCLEOD DR STE 6
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89120-4429
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 754-308-4067
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MICKEY KENDRICK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 321-745-9505
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------