KENCCID (NPI# 1356940183) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1356940183 |
| Entity Type | Organization |
| Organization Name | KENCCID |
| Practice Address |
9350 Ashton Rd Rm 202 Philadelphia PA 19114-7402 |
| Practice Telephone | 2152889797 |
| Mailing Telephone | 2152889797 |
| Enumeration Date | 2020-10-22 |
| Last Update Date | 2020-10-22 |
| Authorized Official Name | MICHAEL ANTHONY DEANGELO (IT SYSTEMS DIRECTOR) |
| Authorized Official Telephone | 2152889797 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 320900000X | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | Residential Treatment Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PA | 100001000 | 05 |
| Other Name | Type Code |
|---|---|
| KenCCID | Doing Business As Name - Organization |
| Street Address |
9350 ASHTON RD RM 202 |
| City | PHILADELPHIA |
| State | PA |
| Zip Code | 19114-7402 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164029906 | Phuoc Nguyen | Nurse Anesthetist, Certified Registered | Jefferson Torresdale Hospital, 10800 Knights Rd, Philadelphia, PA 19114 | 2020-10-05 |
| 1053921932 | Priyanka Patel | Dentist | Philadelphia Dental Smiles, 9140 Academy Road, Philadelphia, PA 19114 | 2020-08-05 |
| 1215419080 | Thomas Patrick Gallagher | Specialist/Technologist | 2708 Ruth Way, Philadelphia, PA 19114 | 2018-08-29 |
| 1558840223 | Alexis Wenger | Early Intervention Provider Agency | 3810 Aubrey Ave, Phila, PA 19114 | 2018-08-13 |
| 1245759232 | Newlands Health | Clinic/Center | 9625 Frankford Ave., Philadelphia, PA 19114 | 2017-09-12 |
| 1619491453 | Nazareth Physician Services Inc | Social Worker | 9815 Roosevelt Blvd Ste G, Philadelphia, PA 19114 | 2017-08-02 |
| 1326561606 | L.s. Share & Love Support Coordinating Agency, LLC | Case Management | 3600 Red Lion Road, Apt 68c, Philadelphia, PA 19114 | 2017-07-19 |
| 1760911952 | Charles C Richards II | Counselor | 2555 Welsh Rd, Apt 407, Philadelphia, PA 19114 | 2017-06-09 |
| 1801338686 | April Neuls | Physical Therapy Assistant | 4213 Lackland Place, Philadelphia, PA 19114 | 2016-11-10 |
| 1114317583 | Siji Cyriac | Physical Therapist | 9501 State Road, Philadelphia, PA 19114 | 2015-01-23 |
| Find all providers in zip 19114 | ||||
| Taxonomy Code | 320900000X |
| Grouping | Residential Treatment Facilities |
| Classification | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities |
| A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518425669 | Marthas Way | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1319 Mcferran St, Philadelphia, PA 19140-2005 | 2019-03-07 |
| 1457819690 | Personal Touch Professional Services II | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 6603 N Gratz St, Philadelphia, PA 19126-2633 | 2019-03-06 |
| 1427531698 | Penn-jersey Integrated Human Services Inc | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 6272 Kindred St, Philadelphia, PA 19149-2805 | 2018-09-12 |
| 1114425691 | Norvetta Naomi Victoria Steward | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1524 N Gratz St, Philadelphia, PA 19121-4125 | 2018-01-30 |
| 1700240496 | Mega Care LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 2704 S 86th St, Philadelphia, PA 19153-1501 | 2016-04-08 |
| 1770947533 | Mega Care LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 2707 S 86th St, Philadelphia, PA 19153 | 2016-04-07 |
| 1518320373 | Providence Corporation | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 7928 Ridge Ave, First Floor, Philadelphia, PA 19128-3011 | 2016-03-30 |
| 1043671712 | Pius Homes LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1333 S 49th St, Philadelphia, PA 19143-4442 | 2016-03-09 |
| 1013372184 | Divine Providence Village | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 6600 Leeds St, Philadelphia, PA 19151-3028 | 2015-12-16 |
| 1578928644 | Divine Providence Village | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 7214 Briar Rd, Philadelphia, PA 19138-1326 | 2015-12-16 |
| Find all providers in PHILADELPHIA | ||||
| City | PHILADELPHIA |
| Zip Code | 19114 |
Please comment or provide details below to improve the information on KENCCID.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.