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General NPI Number Information
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NPI Number | 1629831805
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Entity Type | Organization
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Legal Business Name | KKC HOME CARE SERVICES LLC
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Dates
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Enumeration Date | 01/31/2024
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Last Update Date | 01/31/2024
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Provider Practice Location Address
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Address Line | 1012 W CHELTENHAM AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19126-2314
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Country | US
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Telephone | 267-703-3030
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Fax | 267-703-3031
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Provider Business Mailing Address
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Address Line | 525 EMERSON ST
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City | PHILADELPHIA
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State | PA
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Zip | 19111-1934
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Country | US
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Telephone | 267-703-3030
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Fax | 267-703-3031
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Authorized Official
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Title or Position | CEO & FOUNDER
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Name | KEVIN D NOUCH
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Credential |
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Telephone | 267-703-3030
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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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 | 310400000X
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Taxonomy Name | Assisted Living Facility
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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 | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number |
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License Number State |
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