MEDICARE: KENNEDY HEALTH CARE, INC.

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	253Z00000X	In Home Supportive Care Agency	OT10179	FL

General Provider Information

NPI Number	:	1174877286
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KENNEDY HEALTH CARE, INC.

Provider Business Mailing Address
First Line	:	9273 OLMSTEAD DR
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33467-3603
Country	:	US
Telephone Number	:	561-714-7332
Fax Number	:	561-964-7733

Provider Business Practice Location Address
First Line	:	9273 OLMSTEAD DR
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33467-3603
Country	:	US
Telephone Number	:	561-714-7332
Fax Number	:	561-964-7733

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOHN FRANCIS KENNEDY
Credential	:	OTR/L MOT
Telephone Number	:	561-714-7332

Provider Enumeration Date	:	10/29/2012
Last Update Date	:	12/12/2012

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