Provider Demographics
NPI:1972893907
Name:KENO HOME HEALTH AGENCY, LLC
Entity type:Organization
Organization Name:KENO HOME HEALTH AGENCY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER/ ADMISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:QUEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:OLOMU
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:909-948-8562
Mailing Address - Street 1:1113 ALTA AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-2803
Mailing Address - Country:US
Mailing Address - Phone:909-948-8562
Mailing Address - Fax:909-948-8590
Practice Address - Street 1:1113 ALTA AVE STE 104
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-2803
Practice Address - Country:US
Practice Address - Phone:909-948-8562
Practice Address - Fax:909-948-8590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-11
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health