Healthcare Provider Details

I. General information

NPI: 1609549575
Provider Name (Legal Business Name): KAM'S BLESSING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2021
Last Update Date: 07/29/2021
Certification Date: 07/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

627 PONDVIEW DR
CEDAR HILL TX
75104-6219
US

IV. Provider business mailing address

PO BOX 1193
CEDAR HILL TX
75106-1193
US

V. Phone/Fax

Practice location:
  • Phone: 214-207-4160
  • Fax:
Mailing address:
  • Phone: 214-207-4160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: AZIA GRIFFIN
Title or Position: OWNER
Credential:
Phone: 214-207-4160