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General NPI Number Information
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NPI Number | 1295065266
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Entity Type | Organization
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Legal Business Name | KICO
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Dates
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Enumeration Date | 01/13/2010
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Last Update Date | 01/13/2010
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Provider Practice Location Address
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Address Line | 4931 MESA BONITA
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City | SAN ANTONIO
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State | TX
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Zip | 78218-2756
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Country | US
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Telephone | 210-896-1331
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Fax | 210-896-1331
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Provider Business Mailing Address
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Address Line | 4931 MESA BONITA
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City | SAN ANTONIO
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State | TX
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Zip | 78218-2756
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Country | US
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Telephone | 210-896-1331
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Fax | 210-896-1331
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Authorized Official
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Title or Position | OWNER
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Name | MS. MARY EDITH WEDDINGTON
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Credential |
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Telephone | 210-896-1331
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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 |
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License Number State |
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