Provider Demographics
NPI:1790559870
Name:5-KENS LLC
Entity Type:Organization
Organization Name:5-KENS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN
Authorized Official - Prefix:MR
Authorized Official - First Name:SHEM
Authorized Official - Middle Name:
Authorized Official - Last Name:MOBISA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-514-8879
Mailing Address - Street 1:7096 LITTLEBROOK WAY
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134-7059
Mailing Address - Country:US
Mailing Address - Phone:404-514-8879
Mailing Address - Fax:
Practice Address - Street 1:7096 LITTLEBROOK WAY
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-7059
Practice Address - Country:US
Practice Address - Phone:404-514-8879
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-09
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
No163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Multi-Specialty
No364SH0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistHome HealthGroup - Multi-Specialty