Prominences Kindred Care, LLC

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

Legal business name

PROMINENCES KINDRED CARE, LLC

Practice address

1508 W Arch St Ste a
Tampa, FL 33607-5516

Phone

(717) 678-6321

Fax

(850) 260-0842

NPI assigned

Jan 8, 2025

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Freddie Lee Fagan Jr.

Title

Mr.

Phone

(717) 678-6321

Specialties & licenses 5

Addresses

Other names 1

• Prominences Kindred Care Former legal business name

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1736294400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736294400000",
    "number": "1033929641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1508 W ARCH ST STE A",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336075516",
            "telephone_number": "717-678-6321",
            "fax_number": "850-260-0842"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1508 W ARCH ST STE A",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336075516",
            "telephone_number": "717-678-6321",
            "fax_number": "850-260-0842"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROMINENCES KINDRED CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-01-08",
        "last_updated": "2025-01-08",
        "certification_date": "2025-01-08",
        "status": "A",
        "authorized_official_last_name": "FAGAN",
        "authorized_official_first_name": "FREDDIE",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "MR.",
        "authorized_official_telephone_number": "717-678-6321",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "376J00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Homemaker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "385H00000X",
            "taxonomy_group": "",
            "desc": "Respite Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "385HR2065X",
            "taxonomy_group": "",
            "desc": "Respite Care, Respite Care, Physical Disabilities, Child",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Prominences Kindred Care",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Home Health Agency in Tampa, FL
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.