Provider Demographics
NPI:1902360753
Name:KCG HOME CARE LLC
Entity Type:Organization
Organization Name:KCG HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHANTAY
Authorized Official - Middle Name:CHARISSE
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:HOMEMAKER/COMPANION
Authorized Official - Phone:407-237-0518
Mailing Address - Street 1:5458 HOFFNER AVE STE 304
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32812-2518
Mailing Address - Country:US
Mailing Address - Phone:407-237-0518
Mailing Address - Fax:407-237-0591
Practice Address - Street 1:5458 HOFFNER AVE STE 304
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32812-2518
Practice Address - Country:US
Practice Address - Phone:407-237-0518
Practice Address - Fax:407-237-0591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-25
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care