MEDICARE: MCKENZIE RESIDENTIAL HOME CARE 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	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1205790094
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MCKENZIE RESIDENTIAL HOME CARE LLC

Provider Business Mailing Address
First Line	:	1307 STEPHANIE WAY
Second Line	:	SUITE H
City	:	CHESAPEAKE
State	:	VA
Zip	:	23320
Country	:	US
Telephone Number	:	757-376-5446
Fax Number	:

Provider Business Practice Location Address
First Line	:	1307 STEPHANIE WAY
Second Line	:	SUITE H
City	:	CHESAPEAKE
State	:	VA
Zip	:	23320
Country	:	US
Telephone Number	:	757-376-5446
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ADA MCKENZIE
Credential	:
Telephone Number	:	757-376-5446

Provider Enumeration Date	:	12/15/2025
Last Update Date	:	12/15/2025

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