Provider Demographics
NPI:1811694912
Name:KKC SOUTHWEST, LLC
Entity type:Organization
Organization Name:KKC SOUTHWEST, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:CORNELIUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-603-1725
Mailing Address - Street 1:1430 E MISSOURI AVE STE 280
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-2490
Mailing Address - Country:US
Mailing Address - Phone:602-603-1725
Mailing Address - Fax:602-603-1912
Practice Address - Street 1:1430 E MISSOURI AVE STE 280
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-2490
Practice Address - Country:US
Practice Address - Phone:602-603-1725
Practice Address - Fax:602-603-1912
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOME INSTEAD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-02-09
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care