Provider Demographics
NPI:1083387864
Name:KC'S ANGELSINC.
Entity Type:Organization
Organization Name:KC'S ANGELSINC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AVIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:DECREE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-209-0032
Mailing Address - Street 1:5821 FORT RD
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32443-1957
Mailing Address - Country:US
Mailing Address - Phone:850-209-0032
Mailing Address - Fax:
Practice Address - Street 1:5821 FORT RD
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:FL
Practice Address - Zip Code:32443-1957
Practice Address - Country:US
Practice Address - Phone:850-209-0032
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-28
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care