Provider Demographics
NPI:1841474178
Name:KELS, LLC
Entity type:Organization
Organization Name:KELS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:WINIFRED
Authorized Official - Last Name:SHIVEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-736-3005
Mailing Address - Street 1:4 JAMES DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25705-2353
Mailing Address - Country:US
Mailing Address - Phone:304-736-9424
Mailing Address - Fax:
Practice Address - Street 1:2 COURTYARD LN
Practice Address - Street 2:
Practice Address - City:BARBOURSVILLE
Practice Address - State:WV
Practice Address - Zip Code:25504-1015
Practice Address - Country:US
Practice Address - Phone:304-736-3005
Practice Address - Fax:304-736-2888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-21
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV008751251B00000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810010592Medicaid