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General NPI Number Information
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NPI Number | 1043892706
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Entity Type | Organization
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Legal Business Name | CK TEXAS HOLDINGS INC.
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Dates
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Enumeration Date | 04/22/2021
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Last Update Date | 04/22/2021
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Provider Practice Location Address
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Address Line | 8205 CAMP BOWIE WEST BLVD STE 216
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City | FORT WORTH
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State | TX
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Zip | 76116-6328
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Country | US
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Telephone | 817-560-8085
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Fax | 817-560-7760
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Provider Business Mailing Address
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Address Line | 8205 CAMP BOWIE WEST BLVD STE 216
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City | FORT WORTH
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State | TX
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Zip | 76116-6328
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Country | US
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Telephone | 817-560-8085
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Fax | 817-560-7760
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Authorized Official
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Title or Position | PRESIDENT/ADMINISTRATOR
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Name | MR. SCOTT RYAN VAN DUINEN
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Credential |
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Telephone | 817-560-8085
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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