Provider Demographics
NPI:1679137665
Name:KENZI CARE LLC
Entity Type:Organization
Organization Name:KENZI CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:MATOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-508-2675
Mailing Address - Street 1:2625 CELESTE RD
Mailing Address - Street 2:
Mailing Address - City:WALKERTOWN
Mailing Address - State:NC
Mailing Address - Zip Code:27051
Mailing Address - Country:US
Mailing Address - Phone:336-508-2675
Mailing Address - Fax:
Practice Address - Street 1:668 WOOD RD
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28681
Practice Address - Country:US
Practice Address - Phone:828-635-8351
Practice Address - Fax:828-635-8353
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KENZI CARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-04-25
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility