Provider Demographics
NPI:1952991762
Name:KMP HOME CARE LLC
Entity type:Organization
Organization Name:KMP HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANGER
Authorized Official - Prefix:
Authorized Official - First Name:KEOSHA
Authorized Official - Middle Name:SADE
Authorized Official - Last Name:ROY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-289-6611
Mailing Address - Street 1:4081 MAHOGANY RUN
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33884-2931
Mailing Address - Country:US
Mailing Address - Phone:863-289-6611
Mailing Address - Fax:
Practice Address - Street 1:4081 MAHOGANY RUN
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33884-2931
Practice Address - Country:US
Practice Address - Phone:863-289-6611
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-25
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL237291Medicaid