Healthcare Provider Details

I. General information

NPI: 1710316104
Provider Name (Legal Business Name): KHBW INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2013
Last Update Date: 08/12/2020
Certification Date: 08/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

518 BRANCHWOOD DR
LANCASTER TX
75146-2134
US

IV. Provider business mailing address

1229 E PLEASANT RUN RD STE 222
DESOTO TX
75115-4214
US

V. Phone/Fax

Practice location:
  • Phone: 214-755-0806
  • Fax: 972-572-2612
Mailing address:
  • Phone: 214-364-9034
  • Fax: 972-227-5087

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 Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: MISS BRIDGET WILLIAMS
Title or Position: ADMINISTRATOR
Credential:
Phone: 214-755-0806