Provider Demographics
NPI:1700405982
Name:KYNNCARE HOME & COMMUNITY BASED SERVICES, INC.
Entity Type:Organization
Organization Name:KYNNCARE HOME & COMMUNITY BASED SERVICES, INC.
Other - Org Name:KYNNCARE HOME & COMMUNITY BASED SERVICES, INC.
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-207-8261
Mailing Address - Street 1:4351 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19127-1470
Mailing Address - Country:US
Mailing Address - Phone:215-207-8261
Mailing Address - Fax:
Practice Address - Street 1:4351 MAIN ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19127-1470
Practice Address - Country:US
Practice Address - Phone:215-207-8261
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-08
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA07910501OtherPA DEPT OF HEALTH HOME HEALTH LICENSE NUMBER
PA103768905-0001Medicaid
PA47643601OtherPA DEPT OF HEALTH HCA LICENSE NUMBER