MEDICARE: HEALTHCARE FOR KIDS TX, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3140N1450X	Pediatric Skilled Nursing Facility
2	261QM3000X	Medically Fragile Infants and Children Day Care

General Provider Information

NPI Number	:	1194500157
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHCARE FOR KIDS TX, LLC

Provider Business Mailing Address
First Line	:	576 COLONIAL PARK DR STE 120
Second Line	:
City	:	ROSWELL
State	:	GA
Zip	:	30075-3794
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	16019 NACOGDOCHES RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78247-1118
Country	:	US
Telephone Number	:	239-403-0402
Fax Number	:

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	JOSEPH HARRELSON
Credential	:
Telephone Number	:	239-403-0402

Provider Enumeration Date	:	08/29/2023
Last Update Date	:	06/28/2024

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