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General NPI Number Information
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NPI Number | 1790089712
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Entity Type | Organization
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Legal Business Name | KENDUCK IZQUIERDO SUPPORT SERVICES, INC
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Dates
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Enumeration Date | 01/05/2011
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Last Update Date | 01/05/2011
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Provider Practice Location Address
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Address Line | 7860 SW 204TH AVE
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City | DUNNELLON
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State | FL
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Zip | 34431-5169
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Country | US
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Telephone | 352-362-8074
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Fax | 352-465-3243
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Provider Business Mailing Address
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Address Line | 7860 SW 204TH AVE
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City | DUNNELLON
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State | FL
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Zip | 34431-5169
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Country | US
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Telephone | 352-362-8074
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Fax | 352-465-3243
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Authorized Official
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Title or Position | CO OWNER/PRESIDENT
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Name | MS. BRENDA M KENDUCK
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Credential |
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Telephone | 352-362-8074
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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