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General NPI Number Information
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NPI Number | 1033276936
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Entity Type | Organization
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Legal Business Name | KKS SERVICES, LLC
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Dates
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Enumeration Date | 01/02/2007
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Last Update Date | 07/23/2015
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Provider Practice Location Address
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Address Line | 513 S 1ST ST
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City | LUFKIN
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State | TX
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Zip | 75901-3867
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Country | US
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Telephone | 936-634-1166
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Fax | 936-634-1571
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Provider Business Mailing Address
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Address Line | 513 S 1ST ST
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City | LUFKIN
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State | TX
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Zip | 75901-3867
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Country | US
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Telephone | 936-634-1166
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Fax | 936-634-1571
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Authorized Official
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Title or Position | OWNER/ADMINISTRATOR
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Name | KATHLYN RENE JACKSON
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Credential | RN, MSN
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Telephone | 936-634-1166
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 010019
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 016859
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License Number State | TX
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