Provider Demographics
NPI:1689423634
Name:KALI HAVEN HOMECARE LLC
Entity type:Organization
Organization Name:KALI HAVEN HOMECARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:OSEI
Authorized Official - Last Name:AKOTO
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MPH
Authorized Official - Phone:703-762-6220
Mailing Address - Street 1:169 GREENLEAF MDWS APT A
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14612-4330
Mailing Address - Country:US
Mailing Address - Phone:703-762-6220
Mailing Address - Fax:
Practice Address - Street 1:169 GREENLEAF MDWS APT A
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14612-4330
Practice Address - Country:US
Practice Address - Phone:703-762-6220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-14
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care