Provider Demographics
NPI:1528296654
Name:KELLA HOMES LLC
Entity type:Organization
Organization Name:KELLA HOMES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-752-0235
Mailing Address - Street 1:27153 SW 134TH CT
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-7782
Mailing Address - Country:US
Mailing Address - Phone:786-752-0235
Mailing Address - Fax:786-206-3815
Practice Address - Street 1:27153 SW 134TH CT
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-7782
Practice Address - Country:US
Practice Address - Phone:786-752-0235
Practice Address - Fax:786-206-3815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-26
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLEMT300255374700000X
FL691670896320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental DisabilitiesGroup - Multi-Specialty
No374700000XNursing Service Related ProvidersTechnicianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL691670896Medicaid
FL003174600Medicaid