=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851622724
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KENDELL KARE GROUP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/16/2010
-----------------------------------------------------
Last Update Date | 01/16/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3458 JESSICA RUN
-----------------------------------------------------
City | DECATUR
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30034-6718
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-434-2875
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3458 JESSICA RUN
-----------------------------------------------------
City | DECATUR
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30034-6718
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHAIRMAN OF BOARD
-----------------------------------------------------
Name | MR. DARIUS K RADFORD I
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 404-434-2875
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 311ZA0620X
-----------------------------------------------------
Taxonomy Name | Adult Care Home Facility
-----------------------------------------------------
License Number | 17053233341048
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------