MEDICARE: KINDRED LIGHT SUPPORT 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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1669227427
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KINDRED LIGHT SUPPORT LLC

Provider Business Mailing Address
First Line	:	PO BOX 819
Second Line	:
City	:	CARRBORO
State	:	NC
Zip	:	27510-0819
Country	:	US
Telephone Number	:	919-998-9611
Fax Number	:

Provider Business Practice Location Address
First Line	:	210 W 19TH TER STE 150
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64108-2162
Country	:	US
Telephone Number	:	919-998-9611
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	PIERRE PICKENS
Credential	:
Telephone Number	:	919-998-9611

Provider Enumeration Date	:	04/23/2024
Last Update Date	:	04/23/2024

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Directions to “KINDRED LIGHT SUPPORT LLC ” Practice Location

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