1730135161 NPI number — K & K LIVING CENTER, INC

Table of content: (NPI 1730135161)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730135161 NPI number — K & K LIVING CENTER, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
K & K LIVING CENTER, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730135161
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/11/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 842679
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77284-2679
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-859-9474
Provider Business Mailing Address Fax Number:
281-859-8037

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16802 JUDYLEIGH DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77084-1949
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-859-9474
Provider Business Practice Location Address Fax Number:
281-859-8037
Provider Enumeration Date:
05/26/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MCGRAW
Authorized Official First Name:
DONNIE
Authorized Official Middle Name:
H
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
281-859-9474

Provider Taxonomy Codes

  • Taxonomy code: 320600000X , with the licence number:  000738701/ 000759701 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 320900000X , with the licence number: 0000H08KC , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000738701 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 001009322 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000759701 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".