MEDICARE: KING VISION OF HOUSTON 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	251G00000X	Community Based Hospice Care Agency

General Provider Information

NPI Number	:	1487272258
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KING VISION OF HOUSTON LLC

Provider Business Mailing Address
First Line	:	1906 LAUREL OAKS DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77014-3669
Country	:	US
Telephone Number	:	832-746-2076
Fax Number	:

Provider Business Practice Location Address
First Line	:	1906 LAUREL OAKS DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77014-3669
Country	:	US
Telephone Number	:	832-746-2076
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	SHYKEITHA DOUGLAS
Credential	:
Telephone Number	:	832-746-2076

Provider Enumeration Date	:	07/08/2020
Last Update Date	:	07/08/2020

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