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General NPI Number Information
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NPI Number | 1104030436
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Entity Type | Organization
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Legal Business Name | KENMAR RESIDENTIAL HCS SERVICES INC.
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Dates
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Enumeration Date | 05/09/2007
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Last Update Date | 10/24/2019
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Provider Practice Location Address
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Address Line | 555 ROUND ROCK WEST DR # F-360
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City | ROUND ROCK
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State | TX
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Zip | 78681-5052
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Country | US
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Telephone | 512-334-9192
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Fax |
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Provider Business Mailing Address
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Address Line | 555 ROUND ROCK WEST DR # F-360
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City | ROUND ROCK
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State | TX
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Zip | 78681-5052
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Country | US
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Telephone | 512-334-9192
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | AMANDA PEAKES-TAYLOR
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Credential |
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Telephone | 713-927-9920
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | 001007619
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License Number State | TX
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