Provider Demographics
NPI:1053515445
Name:KINDEST CARE HEALTHCARE LLC
Entity type:Organization
Organization Name:KINDEST CARE HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF NURSING SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:BOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:AMON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:214-394-7679
Mailing Address - Street 1:8400 BUSTLETON AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19152-1918
Mailing Address - Country:US
Mailing Address - Phone:214-394-7679
Mailing Address - Fax:
Practice Address - Street 1:8400 BUSTLETON AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19152-1918
Practice Address - Country:US
Practice Address - Phone:215-639-4646
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN568664163W00000X
PA03230501251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA398104Medicare PIN