Keno Home Health Agency, LLC

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

Legal business name

KENO HOME HEALTH AGENCY, LLC

Practice address

1113 Alta Ave Ste 104
Upland, CA 91786-2803

Phone

(909) 948-8562

Fax

(909) 948-8590

NPI assigned

Apr 11, 2011

Organization subpart

No

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

Authorized official

Name

Mrs. Queen Olomu, LVN

Title

President/Owner/ Admistrator

Phone

(909) 948-8562

Specialties & licenses 1

Addresses

Other names 1

• Keno Home Health Agency, LLC Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Home health agency certification: CCN 059455

Legal name

KENO HOME HEALTH AGENCY LLC

Certification status

Active

Provider type (POS)

Home health agency

Participating since

Jan 10, 2013

Last certification

Dec 6, 2018

Ownership / control type

Proprietary

Organization structure

LLCProprietary

Incorporated

May 13, 2011 in CA

Enrollment address

9360 Santa Anita Ave
Ste 101
Rancho Cucamonga, CA 91730-6151
HHA Branch

Listed as

Keno Home Health Agency LLCCCN 059455

Ownership

Proprietary

Certified

Jan 10, 2013

Medicare certification status

ActiveFrom the Provider of Services file

Services

Nursing, Medical social, Physical therapy, Speech pathology, Occupational therapy

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

All disclosed owners & managing parties 5

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

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

{
    "created_epoch": "1302480000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1711497600000",
    "number": "1972893907",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1113 ALTA AVE STE 104",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917862803",
            "telephone_number": "909-948-8562",
            "fax_number": "909-948-8590"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1113 ALTA AVE STE 104",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917862803",
            "telephone_number": "909-948-8562",
            "fax_number": "909-948-8590"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENO HOME HEALTH AGENCY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-11",
        "last_updated": "2024-03-27",
        "certification_date": "2024-03-27",
        "status": "A",
        "authorized_official_last_name": "OLOMU",
        "authorized_official_first_name": "QUEEN",
        "authorized_official_title_or_position": "PRESIDENT/OWNER/ ADMISTRATOR",
        "authorized_official_telephone_number": "909-948-8562",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LVN"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Keno Home Health Agency, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Thomas Hudson Kelley, D.D.S.
• Trisha Leigh Kellogg
• Isaac Laurence Kelly, M.D.
• Kristen Kennebrew
• Kennedy Hospice, Inc.
• Thomas J Kepic, DDS, MSD
• Kevin M Jenkins DO AMC
• Marjan Khaleghi, NP
• Hammad Khan
• Nadia Khan, M.D.

• Home Health Agency in Upland, CA
• Providers in Upland, CA by specialty
• Home Health Agency in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.