Provider Demographics
NPI:1053092239
Name:KIND HOME CARE, LLC
Entity type:Organization
Organization Name:KIND HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:SHNA
Authorized Official - Middle Name:
Authorized Official - Last Name:FATHULLAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-485-7061
Mailing Address - Street 1:4625 LINDELL BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-3725
Mailing Address - Country:US
Mailing Address - Phone:161-541-9311
Mailing Address - Fax:
Practice Address - Street 1:4625 LINDELL BLVD STE 324
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-3725
Practice Address - Country:US
Practice Address - Phone:161-541-9311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care