1891232104 NPI number — KAMKADE ENTERPRISES LLC

Table of content: (NPI 1891232104)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891232104 NPI number — KAMKADE ENTERPRISES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KAMKADE ENTERPRISES LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HARMONY HOME AND RESPITE CARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1891232104
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/16/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 320234
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLOWOOD
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39232-0234
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
769-251-5006
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4814 LAKELAND DR # A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FLOWOOD
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39232-8694
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
769-251-5006
Provider Business Practice Location Address Fax Number:
769-251-5006
Provider Enumeration Date:
01/24/2017

Additional Information

Authorized Official

Authorized Official Last Name:
DUNSON
Authorized Official First Name:
DEQUARIUS
Authorized Official Middle Name:
T
Authorized Official Title or Position:
MANAGING DIRECTOR
Authorized Official Telephone Number:
769-251-5006

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 253Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 374U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 376J00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 376K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 12115 . This is a "VETERANS ADMINISTRATION" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".




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