NPIMap

Organization Active NPI

Ken Care Services Inc.

  • In Home Supportive Care Agency
  • Hollywood, FL
National Provider Identifier
1679956213
Registry record updated Feb 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
In Home Supportive Care AgencyTaxonomy code 253Z00000X
License
233939 Issued in FL
Legal business name
KEN CARE SERVICES INC.
Practice address
5740 Sheridan St
Hollywood, FL 33021-3251
Phone
(754) 221-0107
Fax
(954) 874-8005
NPI assigned
Jul 1, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 11, 2022

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

Authorized official

Name
Jones Olowoniyi
Title
Owner
Phone
(754) 221-0107

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X
In Home Supportive Care Agency 253Z00000X 233939 FL Primary

Addresses

Primary practice location

5740 Sheridan St
Hollywood, FL 33021-3251

Mailing address

5740 Sheridan St
Hollywood, FL 33021-3251
Phone (754) 221-0107

Other identifiers 1

IdentifierTypeStateIssuer
022359201MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20191230002367 FL Part A Provider - Home Health Agency 6608200548 1 other NPI on this enrollment
Practice locations: Hollywood, FL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1679956213. Details of each certification follow.

Home health agency certification: CCN 687129

Legal name
KEN CARE SERVICES INC.
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Aug 4, 2021
Last certification
Jul 21, 2021
Organization structure
CorporationProprietary
Incorporated
Jan 6, 2015 in FL
Enrollment address
5740 Sheridan St
Hollywood, FL 33021-3251

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Home health agency

Medicare Care Compare
Listed as
Ken Care Services, LLCCCN 687129 · All quality measures
Ownership
-
Certified
Aug 4, 2021
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Oyefemi Olowoniyi Individual 5% Or Greater Direct Ownership Interest Jan 6, 2015 50%
Corporate Officer Jan 6, 2015 50%
Corporate Director Jan 6, 2015 50%
W-2 Managing Employee Jan 6, 2015 50%
Oluyemi Awe Individual Corporate OfficerAlt Adminstrator Jul 22, 2019
Corporate DirectorAlt Administrator Jul 22, 2019
W-2 Managing EmployeeAlt Adminsitrator Jul 22, 2019
Jones Olowoniyi Individual 5% Or Greater Direct Ownership Interest Jan 6, 2015 50%
Corporate Officer Jan 6, 2015 50%
Corporate Director Jan 6, 2015 50%
W-2 Managing Employee Jan 6, 2015 50%

NPI Registry JSON

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

{
    "created_epoch": "1435708800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1644537600000",
    "number": "1679956213",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5740 SHERIDAN ST",
            "city": "HOLLYWOOD",
            "state": "FL",
            "postal_code": "330213251",
            "telephone_number": "754-221-0107",
            "fax_number": "954-874-8005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5740 SHERIDAN ST",
            "city": "HOLLYWOOD",
            "state": "FL",
            "postal_code": "330213251",
            "telephone_number": "754-221-0107",
            "fax_number": "954-874-8005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEN CARE SERVICES INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-01",
        "last_updated": "2022-02-11",
        "certification_date": "2022-02-11",
        "status": "A",
        "authorized_official_last_name": "OLOWONIYI",
        "authorized_official_first_name": "JONES",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "754-221-0107"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": "FL",
            "license": "233939",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "022359201",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hollywood, FL

Sources for this page

Verify at the official NPI Registry.