Provider Demographics
NPI:1487970513
Name:KMI CARE
Entity type:Organization
Organization Name:KMI CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTAGNA
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:623-561-1144
Mailing Address - Street 1:20280 N 59TH AVE
Mailing Address - Street 2:STE 115-439
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-6850
Mailing Address - Country:US
Mailing Address - Phone:623-561-1144
Mailing Address - Fax:623-561-0662
Practice Address - Street 1:6630 W TONOPAH DR
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-6626
Practice Address - Country:US
Practice Address - Phone:623-561-1144
Practice Address - Fax:623-561-0662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-14
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ505388OtherAHCCCS