=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336217751
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KENMAR RESIDENTIAL SERVICES, INCORPORATED
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/01/2006
-----------------------------------------------------
Last Update Date | 12/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3112 CEDAR HL
-----------------------------------------------------
City | DENTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76209-8350
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-336-0800
-----------------------------------------------------
Fax | 512-336-0812
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 33 CYPRESS BLVD STE 100
-----------------------------------------------------
City | ROUND ROCK
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78665-1006
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-336-0800
-----------------------------------------------------
Fax | 512-336-0812
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE VICE PRESIDENT
-----------------------------------------------------
Name | AMANDA PEAKES-TAYLOR
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 713-927-9920
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 320900000X
-----------------------------------------------------
Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
-----------------------------------------------------
License Number | 115067
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------