Provider Demographics
NPI:1538570676
Name:THE KENKOU GROUP - SOUTH, LLC
Entity type:Organization
Organization Name:THE KENKOU GROUP - SOUTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:EDOUARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-299-4393
Mailing Address - Street 1:4700 MILLENIA BLVD
Mailing Address - Street 2:SUITE 175
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32839-6013
Mailing Address - Country:US
Mailing Address - Phone:407-810-7617
Mailing Address - Fax:
Practice Address - Street 1:4700 MILLENIA BLVD
Practice Address - Street 2:SUITE 175
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32839-6013
Practice Address - Country:US
Practice Address - Phone:407-810-7617
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE KENKOU GROUP, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-05-12
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health