MEDICARE: ANTWAINE MAURICE KENNEDY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374U00000X	Home Health Aide		OH

General Provider Information

NPI Number	:	1114576386
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTWAINE MAURICE KENNEDY

Provider Business Mailing Address
First Line	:	24400 RUSSELL AVE
Second Line	:
City	:	EUCLID
State	:	OH
Zip	:	44123-2313
Country	:	US
Telephone Number	:	216-849-1860
Fax Number	:

Provider Business Practice Location Address
First Line	:	24400 RUSSELL AVE
Second Line	:
City	:	EUCLID
State	:	OH
Zip	:	44123-2313
Country	:	US
Telephone Number	:	216-849-1860
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/10/2019
Last Update Date	:	11/27/2023

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Directions to “ ANTWAINE MAURICE KENNEDY ” Practice Location

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