MEDICARE: K & V COMMUNITY HEALTH SERVICES INC.

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	:	1770292989
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	K & V COMMUNITY HEALTH SERVICES INC.

Provider Business Mailing Address
First Line	:	9145 NARCOOSSEE RD
Second Line	:	SUITE 106 PMB 109
City	:	ORLANDO
State	:	FL
Zip	:	32827
Country	:	US
Telephone Number	:	407-924-2124
Fax Number	:

Provider Business Practice Location Address
First Line	:	5393 CARRARA CT
Second Line	:
City	:	SAINT CLOUD
State	:	FL
Zip	:	34771-8048
Country	:	US
Telephone Number	:	407-924-2124
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KHALIL COLLAZO
Credential	:
Telephone Number	:	407-924-2124

Provider Enumeration Date	:	11/16/2022
Last Update Date	:	11/16/2022

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