Healthcare Provider Details

I. General information

NPI: 1518955145
Provider Name (Legal Business Name): H K A CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2005
Last Update Date: 12/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 S EDDY ST
PECOS TX
79772-6420
US

IV. Provider business mailing address

PO BOX 472
PECOS TX
79772-0472
US

V. Phone/Fax

Practice location:
  • Phone: 432-445-3330
  • Fax: 432-445-3331
Mailing address:
  • Phone: 432-445-3330
  • Fax: 432-445-3331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number00230
License Number StateTX

VIII. Authorized Official

Name: MS. IRMA CASTILLO
Title or Position: OFFICE MANAGER
Credential:
Phone: 432-445-3330