Provider Demographics
NPI:1508278300
Name:KC HOME CARE SERVICES
Entity Type:Organization
Organization Name:KC HOME CARE SERVICES
Other - Org Name:NA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KHAALIS
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-629-0688
Mailing Address - Street 1:18527 VAUGHAN
Mailing Address - Street 2:18527 VAUGHAN
Mailing Address - City:DETROIT
Mailing Address - State:DETOIT
Mailing Address - Zip Code:48219
Mailing Address - Country:UM
Mailing Address - Phone:313-629-0688
Mailing Address - Fax:
Practice Address - Street 1:18527 VAUGHAN
Practice Address - Street 2:18527 VAUGHAN
Practice Address - City:DETROIT
Practice Address - State:DETOIT
Practice Address - Zip Code:48219
Practice Address - Country:UM
Practice Address - Phone:313-629-0688
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-28
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2300050320203000251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health