=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518053040
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KAMCARE HOME HEALTH SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/04/2006
-----------------------------------------------------
Last Update Date | 05/09/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 136 OLD MILL CTR
-----------------------------------------------------
City | LIVINGSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77351-6339
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 866-344-2821
-----------------------------------------------------
Fax | 866-288-4125
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 136 OLD MILL CTR
-----------------------------------------------------
City | LIVINGSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77351-6339
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 866-344-2821
-----------------------------------------------------
Fax | 866-288-4125
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP
-----------------------------------------------------
Name | CASEY ALLEN WILSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 936-856-6888
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 011503
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------