Healthcare Provider Details

I. General information

NPI: 1215702626
Provider Name (Legal Business Name): KMT HOME HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2023
Last Update Date: 11/16/2023
Certification Date: 11/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 MCCORD WAY APT 1021
FRISCO TX
75033-1157
US

IV. Provider business mailing address

1801 MCCORD WAY APT 1021
FRISCO TX
75033-1157
US

V. Phone/Fax

Practice location:
  • Phone: 240-498-7219
  • Fax: 469-582-0172
Mailing address:
  • Phone: 240-498-7219
  • Fax: 469-582-0172

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 Code372500000X
TaxonomyChore Provider
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: KEVIN TABE
Title or Position: OWNER
Credential:
Phone: 240-498-7219