MEDICARE: KAYKANESHOME CARE PROVIDERES SERVICES

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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1831046465
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KAYKANESHOME CARE PROVIDERES SERVICES

Provider Business Mailing Address
First Line	:	601 E 260TH ST
Second Line	:
City	:	EUCLID
State	:	OH
Zip	:	44132-1950
Country	:	US
Telephone Number	:	216-512-9601
Fax Number	:

Provider Business Practice Location Address
First Line	:	601 E 260TH ST
Second Line	:
City	:	EUCLID
State	:	OH
Zip	:	44132-1950
Country	:	US
Telephone Number	:	216-512-9601
Fax Number	:	216-512-9601

Authorized Official
Title or Position	:	OWNER
Name	:	MS. LAKITA DENISE WHITE
Credential	:
Telephone Number	:	216-512-9601

Provider Enumeration Date	:	03/12/2026
Last Update Date	:	03/12/2026

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