MEDICARE: K KARESM LLC

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

General Provider Information

NPI Number	:	1184281339
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	K KARESM LLC

Provider Business Mailing Address
First Line	:	PO BOX 4882
Second Line	:
City	:	HILTON HEAD
State	:	SC
Zip	:	29938-4882
Country	:	US
Telephone Number	:	843-683-4168
Fax Number	:

Provider Business Practice Location Address
First Line	:	2 ANCHORAGE PT
Second Line	:
City	:	HILTON HEAD
State	:	SC
Zip	:	29928-3047
Country	:	US
Telephone Number	:	843-683-4168
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KAREN KATHLEEN KELLEY
Credential	:	CNA
Telephone Number	:	843-683-4168

Provider Enumeration Date	:	05/23/2019
Last Update Date	:	05/23/2019

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