Provider Demographics
NPI:1912332826
Name:KIAWAH, LLC
Entity Type:Organization
Organization Name:KIAWAH, LLC
Other - Org Name:GRISWOLD HOME CARE-BOYNTON/DELRAY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:MANDALA
Authorized Official - Suffix:
Authorized Official - Credentials:CSA
Authorized Official - Phone:732-236-5968
Mailing Address - Street 1:2 COLONIAL CT
Mailing Address - Street 2:
Mailing Address - City:PLAINSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08536-3113
Mailing Address - Country:US
Mailing Address - Phone:732-236-5968
Mailing Address - Fax:609-799-8070
Practice Address - Street 1:2200 N FEDERAL HWY
Practice Address - Street 2:SUITE 212
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-7766
Practice Address - Country:US
Practice Address - Phone:561-218-4391
Practice Address - Fax:561-298-4527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-10
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care