Healthcare Provider Details

I. General information

NPI: 1255482733
Provider Name (Legal Business Name): KAECORP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12626 LA ENTRADA ST
SAN ANTONIO TX
78233-6328
US

IV. Provider business mailing address

PO BOX 65221
SAN ANTONIO TX
78265-5221
US

V. Phone/Fax

Practice location:
  • Phone: 210-264-2246
  • Fax: 210-637-7015
Mailing address:
  • Phone: 210-264-2246
  • Fax: 210-637-7015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number35239
License Number StateTX

VIII. Authorized Official

Name: MS. LINDA KAY RAMIREZ
Title or Position: CEO
Credential: LBSW
Phone: 210-264-2246