Provider Demographics
NPI:1114197571
Name:KENZIE KARE GROUP HOME
Entity Type:Organization
Organization Name:KENZIE KARE GROUP HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CASSANDRA
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:MCKENZIE
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE MSN
Authorized Official - Phone:239-834-4300
Mailing Address - Street 1:919 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33972-2921
Mailing Address - Country:US
Mailing Address - Phone:239-369-6448
Mailing Address - Fax:239-902-9887
Practice Address - Street 1:919 5TH AVE
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33972-2921
Practice Address - Country:US
Practice Address - Phone:239-369-6448
Practice Address - Fax:239-902-9887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-01
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home