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General NPI Number Information
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NPI Number | 1417104712
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Entity Type | Organization
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Legal Business Name | PATRIOT HEALTHCARE, LLC
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Dates
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Enumeration Date | 08/19/2008
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Last Update Date | 08/19/2008
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Provider Practice Location Address
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Address Line | 217020 KINGSLAND BLVE STE 301
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City | KATY
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State | TX
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Zip | 77450-2513
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Country | US
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Telephone | 281-589-2900
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Fax | 281-558-1395
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Provider Business Mailing Address
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Address Line | 21720 KINGSLAND BLVD., SUITE 301
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City | KATY
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State | TX
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Zip | 77450-2513
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Country | US
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Telephone | 281-589-2900
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Fax | 281-558-1395
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Authorized Official
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Title or Position | CEO
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Name | KENNETH RAY KOEPKE
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Credential |
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Telephone | 281-579-5662
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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 |
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License Number State |
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