Provider Demographics
NPI:1245632561
Name:KINDALLE HOME HEALTHCARE LLC
Entity type:Organization
Organization Name:KINDALLE HOME HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ELBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-484-7179
Mailing Address - Street 1:7305 ROKEBY DR
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20109-6404
Mailing Address - Country:US
Mailing Address - Phone:571-292-1327
Mailing Address - Fax:703-543-5477
Practice Address - Street 1:7305 ROKEBY DR
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-6404
Practice Address - Country:US
Practice Address - Phone:571-292-1327
Practice Address - Fax:703-543-5477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-17
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO151211251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health