Provider Demographics
NPI:1821197344
Name:KENDALL HOME HEALTH AGENCY
Entity Type:Organization
Organization Name:KENDALL HOME HEALTH AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:FREDERICK
Authorized Official - Last Name:AVILES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-234-1828
Mailing Address - Street 1:13200 SW 128TH ST
Mailing Address - Street 2:SUITE A-2
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-5881
Mailing Address - Country:US
Mailing Address - Phone:305-234-1828
Mailing Address - Fax:305-234-1830
Practice Address - Street 1:13200 SW 128TH ST
Practice Address - Street 2:SUITE A2
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-5881
Practice Address - Country:US
Practice Address - Phone:305-234-1828
Practice Address - Fax:305-234-1830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health