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General NPI Number Information
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NPI Number | 1326815770
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Entity Type | Organization
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Legal Business Name | KESI CARE SERVICES LLC
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Dates
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Enumeration Date | 12/06/2023
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Last Update Date | 01/29/2024
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Provider Practice Location Address
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Address Line | 1909 LEADERS LN
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City | LEANDER
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State | TX
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Zip | 78641-3142
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Country | US
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Telephone | 512-269-5633
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Fax |
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Provider Business Mailing Address
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Address Line | 1909 LEADERS LN # A
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City | LEANDER
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State | TX
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Zip | 78641-3142
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Country | US
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Telephone | 512-269-5633
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Fax |
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Authorized Official
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Title or Position | MANAGER/OWNER
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Name | PETER JAMES MAGOMBO
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Credential |
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Telephone | 512-269-5633
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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