Healthcare Provider Details

I. General information

NPI: 1881878254
Provider Name (Legal Business Name): KUKU NEST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2007
Last Update Date: 06/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 CHASE HILL LN
BURLESON TX
76028-7082
US

IV. Provider business mailing address

316 CHASE HILL LN
BURLESON TX
76028-7082
US

V. Phone/Fax

Practice location:
  • Phone: 817-797-2887
  • Fax:
Mailing address:
  • Phone: 817-797-2887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. CHARLENE ABLA AWADJIE
Title or Position: OPERATIONS MANAGER
Credential: MA, MAOM
Phone: 817-797-2887