Provider Demographics
NPI:1669608311
Name:KENWAYS DISTRIBUTIONS, LLC
Entity type:Organization
Organization Name:KENWAYS DISTRIBUTIONS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:KIMUKUN
Authorized Official - Last Name:BIWOT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-704-5344
Mailing Address - Street 1:4640 HEDGCOXE RD
Mailing Address - Street 2:APT 1521
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-3885
Mailing Address - Country:US
Mailing Address - Phone:972-704-5344
Mailing Address - Fax:
Practice Address - Street 1:4640 HEDGCOXE RD
Practice Address - Street 2:APT 1521
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-3885
Practice Address - Country:US
Practice Address - Phone:972-704-5344
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-09
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX253Z00000X253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care