Provider Demographics
NPI:1215773577
Name:KMK CARE LLC
Entity type:Organization
Organization Name:KMK CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED NURSE/ ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MANINGBE
Authorized Official - Middle Name:
Authorized Official - Last Name:FOFANA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:317-789-6127
Mailing Address - Street 1:12703 COURAGE XING
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-5963
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12703 COURAGE XING
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-5963
Practice Address - Country:US
Practice Address - Phone:317-789-6127
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-06
Last Update Date:2024-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No347C00000XTransportation ServicesPrivate Vehicle