Provider Demographics
NPI:1730721259
Name:KENDACH
Entity type:Organization
Organization Name:KENDACH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BCBA
Authorized Official - Prefix:
Authorized Official - First Name:ROMINA
Authorized Official - Middle Name:KAMBAJI
Authorized Official - Last Name:ILUNGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-536-8943
Mailing Address - Street 1:3650 S BROADWAY APT A228
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80113-3634
Mailing Address - Country:US
Mailing Address - Phone:818-536-8943
Mailing Address - Fax:
Practice Address - Street 1:3650 S BROADWAY APT A228
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-3634
Practice Address - Country:US
Practice Address - Phone:818-536-8943
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-16
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty