MEDICARE: KING-DAVIS ENTERPRISE L.L.C.

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	385H00000X	Respite Care

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	803310259	OTHER	TX	SECRETARY OF STATE FILE NUMBER

General Provider Information

NPI Number	:	1528687639
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KING-DAVIS ENTERPRISE L.L.C.

Provider Business Mailing Address
First Line	:	3945 BRAXTON DR STE 2
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77063-6303
Country	:	US
Telephone Number	:	281-636-6861
Fax Number	:

Provider Business Practice Location Address
First Line	:	3945 BRAXTON DR STE 2
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77063-6303
Country	:	US
Telephone Number	:	281-636-6861
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	KATHY DELOIS KING-DAVIS
Credential	:	FNP
Telephone Number	:	281-636-6861

Provider Enumeration Date	:	04/09/2020
Last Update Date	:	05/27/2020

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Directions to “KING-DAVIS ENTERPRISE L.L.C. ” Practice Location

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