MEDICARE: R & K SPECIALIZED HOMES, INC.

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	315P00000X	Intellectual Disabilities Intermediate Care Facility	001018537	TX
2	315P00000X	Intellectual Disabilities Intermediate Care Facility	001019163	TX
3	315P00000X	Intellectual Disabilities Intermediate Care Facility	001020880	TX
4	315P00000X	Intellectual Disabilities Intermediate Care Facility	01021060	TX
5	251E00000X	Home Health Agency	01007452	TX
6	315P00000X	Intellectual Disabilities Intermediate Care Facility	000721501	TX
7	315P00000X	Intellectual Disabilities Intermediate Care Facility	001018787	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000721501	OTHER	TX	INTRIGUE
2	001031043	OTHER	TX	RIMWOOD
3	001028361	OTHER	TX	CLYDE DENT
4	01007452	OTHER	TX	HCS PROGRAM
5	001019163	OTHER	TX	QUAIL CIRCLE
6	001020880	OTHER	TX	OAK LEDGE
7	001021060	OTHER	TX	TIMBERHILL
8	001018787	OTHER	TX	SHADY BREEZE
9	001018537	OTHER	TX	SQUANTO

General Provider Information

NPI Number	:	1346386679
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	R & K SPECIALIZED HOMES, INC.

Provider Business Mailing Address
First Line	:	PO BOX 17897
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78217-0897
Country	:	US
Telephone Number	:	210-710-4999
Fax Number	:	210-568-6213

Provider Business Practice Location Address
First Line	:	8802 BROADWAY
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78217-6318
Country	:	US
Telephone Number	:	210-710-4999
Fax Number	:	210-568-6213

Authorized Official
Title or Position	:	CEO/OWNER
Name	:	ESEQUIEL HERNANDEZ IV
Credential	:
Telephone Number	:	210-843-4413

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	06/24/2024

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