Provider Demographics
NPI:1770294795
Name:KELANDY LLC
Entity type:Organization
Organization Name:KELANDY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KELVIN
Authorized Official - Middle Name:ANDERSON
Authorized Official - Last Name:NKIZAYEZU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-776-0170
Mailing Address - Street 1:17 WERMUTH RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-1817
Mailing Address - Country:US
Mailing Address - Phone:207-776-0170
Mailing Address - Fax:
Practice Address - Street 1:125 GRANT ST APT 11
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-2163
Practice Address - Country:US
Practice Address - Phone:331-442-9596
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-09
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1376254789OtherDRIVER