MEDICARE: MARIE KENANDE ST CLOUD

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
2	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1720840796
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIE KENANDE ST CLOUD

Provider Business Mailing Address
First Line	:	8710 NW 3RD ST
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33024-6508
Country	:	US
Telephone Number	:	754-217-0825
Fax Number	:

Provider Business Practice Location Address
First Line	:	1319 BUCHANAN ST NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20011-4446
Country	:	US
Telephone Number	:	240-636-0077
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/25/2024
Last Update Date	:	02/26/2025

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Directions to “ MARIE KENANDE ST CLOUD ” Practice Location

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