Healthcare Provider Details

I. General information

NPI: 1346975158
Provider Name (Legal Business Name): SCAL KINGSLAND LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2022
Last Update Date: 03/15/2023
Certification Date: 07/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 COVENANT LN
KINGSLAND TX
78639-5939
US

IV. Provider business mailing address

2501 E HEBRON PKWY STE 100C
CARROLLTON TX
75010-4468
US

V. Phone/Fax

Practice location:
  • Phone: 866-304-6801
  • Fax: 972-300-3640
Mailing address:
  • Phone: 866-304-6801
  • Fax: 972-300-3640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. MUNDEE R CHILDERS
Title or Position: INFOADMIN OFCMGR
Credential:
Phone: 866-304-6801