=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750940193
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | K & C CARE SERVICES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/10/2019
-----------------------------------------------------
Last Update Date | 02/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 900 SW 84TH AVE APT 215
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33144-4104
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-317-9024
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 175 FONTAINEBLEAU BLVD STE 1R2
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33172-7023
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-317-9024
-----------------------------------------------------
Fax | 786-359-4020
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | ODALIS CABALLERO MAYTIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 786-317-9024
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------