Provider Demographics
NPI:1609897586
Name:KENOLY HOME CARE, LLC
Entity Type:Organization
Organization Name:KENOLY HOME CARE, LLC
Other - Org Name:KENDAL HOME CARE, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINISTRATOR/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:KEKELWA
Authorized Official - Middle Name:NOLIYA
Authorized Official - Last Name:DALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-573-3852
Mailing Address - Street 1:8303 ARLINGTON BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-2903
Mailing Address - Country:US
Mailing Address - Phone:703-573-3852
Mailing Address - Fax:703-573-3853
Practice Address - Street 1:8303 ARLINGTON BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-2903
Practice Address - Country:US
Practice Address - Phone:703-573-3852
Practice Address - Fax:703-573-3853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO 264251E00000X
VAHCO264251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251E00000XAgenciesHome Health
Not Answered251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD248092OtherKAISER PMNTE PROVIDER