Healthcare Provider Details

I. General information

NPI: 1164514006
Provider Name (Legal Business Name): KC HEALTHCARE & REHABILITATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 01/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7100 REGENCY SQUARE BLVD SUITE 248A
HOUSTON TX
77036-3202
US

IV. Provider business mailing address

7100 REGENCY SQUARE BLVD SUITE 248A
HOUSTON TX
77036-3202
US

V. Phone/Fax

Practice location:
  • Phone: 713-781-2050
  • Fax: 281-238-9812
Mailing address:
  • Phone: 713-781-2050
  • Fax: 281-238-9812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License Number172605
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. CHUKA ORAKPO
Title or Position: COMPLIANCE OFFICER
Credential:
Phone: 713-781-2050