Provider Demographics
NPI:1417568221
Name:KDS PREFERRED HOME CARE AGENCY LLC
Entity Type:Organization
Organization Name:KDS PREFERRED HOME CARE AGENCY LLC
Other - Org Name:KDS PREFERRED HOME CARE AGENCY LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DORETHA
Authorized Official - Middle Name:SHANTE
Authorized Official - Last Name:DONALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-614-7812
Mailing Address - Street 1:55 S PROGRESS AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17109-4600
Mailing Address - Country:US
Mailing Address - Phone:717-695-6548
Mailing Address - Fax:
Practice Address - Street 1:55 S PROGRESS AVE STE 3
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17109-4600
Practice Address - Country:US
Practice Address - Phone:717-695-6548
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-14
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care