Healthcare Provider Details

I. General information

NPI: 1790554277
Provider Name (Legal Business Name): KECHIKA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2023
Last Update Date: 12/26/2023
Certification Date: 12/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 COUNTY ROAD 94 APT 17102
MANVEL TX
77578-3055
US

IV. Provider business mailing address

3800 COUNTY ROAD 94 APT 17102
MANVEL TX
77578-3055
US

V. Phone/Fax

Practice location:
  • Phone: 281-651-8916
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MR. ANTHONY ACHIFE
Title or Position: MANAGING PARTNER
Credential:
Phone: 281-651-8916