MEDICARE: KJ HOMECARE 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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1255007233
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KJ HOMECARE LLC

Provider Business Mailing Address
First Line	:	3851 CAVANAUGH RD
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45405-2143
Country	:	US
Telephone Number	:	937-813-3133
Fax Number	:	937-813-8223

Provider Business Practice Location Address
First Line	:	3851 CAVANAUGH RD
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45405-2143
Country	:	US
Telephone Number	:	937-813-3133
Fax Number	:	937-813-8223

Authorized Official
Title or Position	:	OWNER
Name	:	LAQUADA CASEY
Credential	:
Telephone Number	:	937-813-3133

Provider Enumeration Date	:	08/19/2021
Last Update Date	:	03/02/2026

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