Organization
KINAM, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARLENE J FISH (WAIVER PROVIDER)
(813) 850-2497
Entity
Organization
Contact information
Practice address
3908 SEIXAS PL, LAND O LAKES, FL 34639-4500
(813) 850-2497
Mailing address
3908 SEIXAS PL, LAND O LAKES, FL 34639-4500
(813) 850-2497
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
691176596
—
FL
Enumeration date
02/11/2022
Last updated
02/11/2022
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