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General NPI Number Information
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NPI Number | 1518168483
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Entity Type | Organization
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Legal Business Name | KENWELL HOME
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Dates
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Enumeration Date | 05/30/2007
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Last Update Date | 08/12/2008
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Provider Practice Location Address
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Address Line | 6614 KENWELL ST
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City | DALLAS
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State | TX
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Zip | 75209-5344
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Country | US
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Telephone | 214-904-1734
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Fax |
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Provider Business Mailing Address
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Address Line | 6614 KENWELL ST
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City | DALLAS
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State | TX
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Zip | 75209-5344
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Country | US
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Telephone | 214-904-1734
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Fax |
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Authorized Official
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Title or Position | HOME ADMINISTRATOR
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Name | MR. LOUIS DAVID GROOM
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Credential |
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Telephone | 214-904-1734
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320700000X
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Taxonomy Name | Physical Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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