Healthcare Provider Details

I. General information

NPI: 1407535412
Provider Name (Legal Business Name): KIDDERCARE HOME HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2023
Last Update Date: 07/17/2023
Certification Date: 07/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19906 STANTON LAKE DR
CYPRESS TX
77433-2670
US

IV. Provider business mailing address

19906 STANTON LAKE DR
CYPRESS TX
77433-2670
US

V. Phone/Fax

Practice location:
  • Phone: 713-385-7986
  • Fax:
Mailing address:
  • Phone: 713-385-7986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. KILLIAN NKWAIN FULTANG
Title or Position: ADMINISTRATOR
Credential:
Phone: 713-385-7986