Healthcare Provider Details

I. General information

NPI: 1881444768
Provider Name (Legal Business Name): MKB COMMUNITY LIVING,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2024
Last Update Date: 03/25/2024
Certification Date: 03/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2004 HUNTINGDON AVE
DALLAS TX
75203-4222
US

IV. Provider business mailing address

617 CRESENT DR
DESOTO TX
75115-8017
US

V. Phone/Fax

Practice location:
  • Phone: 817-233-0276
  • Fax:
Mailing address:
  • Phone: 817-233-0276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: KESEYA BOYD
Title or Position: CFO
Credential: RN
Phone: 817-233-0276