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General NPI Number Information
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NPI Number | 1366733180
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Entity Type | Organization
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Legal Business Name | KENNENER AND JENKINS COMMUNITY SERVICES, INC.
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Dates
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Enumeration Date | 04/27/2011
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Last Update Date | 04/27/2011
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Provider Practice Location Address
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Address Line | 1909 WEST LOOP
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City | EL CAMPO
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State | TX
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Zip | 77437-8014
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Country | US
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Telephone | 979-543-4186
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Fax |
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Provider Business Mailing Address
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Address Line | 1909 WEST LOOP
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City | EL CAMPO
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State | TX
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Zip | 77437
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Country | US
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Telephone | 979-543-4186
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | EVERET E. KENNENER IV
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Credential |
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Telephone | 979-297-7971
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 | 125528
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License Number State | TX
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