Provider Demographics
NPI:1992538201
Name:KINCARE HOME CARE AGENCY LLC
Entity type:Organization
Organization Name:KINCARE HOME CARE AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RANDERS
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-436-2823
Mailing Address - Street 1:56 SUNGLO DR
Mailing Address - Street 2:
Mailing Address - City:LEESPORT
Mailing Address - State:PA
Mailing Address - Zip Code:19533-8672
Mailing Address - Country:US
Mailing Address - Phone:484-750-5092
Mailing Address - Fax:484-214-1360
Practice Address - Street 1:56 SUNGLO DR
Practice Address - Street 2:
Practice Address - City:LEESPORT
Practice Address - State:PA
Practice Address - Zip Code:19533-8672
Practice Address - Country:US
Practice Address - Phone:484-750-5092
Practice Address - Fax:484-214-1360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-22
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health