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General NPI Number Information
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NPI Number | 1942015813
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Entity Type | Organization
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Legal Business Name | KINSHIP PACE OF INDIANA LLC
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Dates
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Enumeration Date | 02/10/2025
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Last Update Date | 02/10/2025
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Provider Practice Location Address
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Address Line | 1453 E 10TH ST
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City | JEFFERSONVILLE
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State | IN
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Zip | 47130-4204
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Country | US
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Telephone | 570-371-7371
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Fax |
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Provider Business Mailing Address
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Address Line | 885 3RD AVE FL 29
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City | NEW YORK
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State | NY
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Zip | 10022-4834
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | INTERIM CEO, CHIEF STRATEGY OFFICER
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Name | JUDY KOHN
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Credential |
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Telephone | 917-270-0599
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251T00000X
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Taxonomy Name | PACE Provider Organization
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License Number |
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License Number State |
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