Provider Demographics
NPI:1427826403
Name:STANFORD, KENDRICK KEYMEN
Entity type:Individual
Prefix:
First Name:KENDRICK
Middle Name:KEYMEN
Last Name:STANFORD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 MILES AVE NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708-3657
Mailing Address - Country:US
Mailing Address - Phone:330-280-1322
Mailing Address - Fax:
Practice Address - Street 1:915 MILES AVE NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-3657
Practice Address - Country:US
Practice Address - Phone:330-280-1322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-19
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide