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General NPI Number Information
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NPI Number | 1427699842
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Entity Type | Organization
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Legal Business Name | KINDFUL CARE LLC
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Dates
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Enumeration Date | 10/07/2019
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Last Update Date | 10/07/2019
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Provider Practice Location Address
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Address Line | 117 S BROADWAY AVE
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City | ADA
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State | OK
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Zip | 74820-5801
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Country | US
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Telephone | 580-332-6900
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Fax |
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Provider Business Mailing Address
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Address Line | 117 S BROADWAY AVE
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City | ADA
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State | OK
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Zip | 74820-5801
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | RUSS KRENGEL
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Credential |
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Telephone | 512-799-2651
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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