Provider Demographics
NPI:1154684769
Name:KINETIC HOME HEALTH, LLC
Entity Type:Organization
Organization Name:KINETIC HOME HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LORRAINE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HENDRICKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-551-0329
Mailing Address - Street 1:4237 SALISBURY RD STE 114
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-0904
Mailing Address - Country:US
Mailing Address - Phone:904-551-0329
Mailing Address - Fax:904-352-2303
Practice Address - Street 1:4237 SALISBURY RD STE 114
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-0904
Practice Address - Country:US
Practice Address - Phone:904-551-0329
Practice Address - Fax:904-352-2303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-19
Last Update Date:2019-02-18
Deactivation Date:2015-09-21
Deactivation Code:
Reactivation Date:2015-10-21
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health