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General NPI Number Information
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NPI Number | 1174823330
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Entity Type | Organization
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Legal Business Name | KGBELLOS RESIDENTIAL CARE, INC.
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Dates
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Enumeration Date | 10/21/2010
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Last Update Date | 11/15/2011
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Provider Practice Location Address
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Address Line | 2015 VISTA DR
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City | LEWISVILLE
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State | TX
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Zip | 75067-7474
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Country | US
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Telephone | 214-253-7486
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Fax | 214-488-5983
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Provider Business Mailing Address
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Address Line | 2015 VISTA DR
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City | LEWISVILLE
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State | TX
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Zip | 75067-7474
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Country | US
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Telephone | 214-253-7486
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Fax | 214-488-5983
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. ONYEKACHI OKORO
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Credential |
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Telephone | 214-253-7486
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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 | 014332
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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