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General NPI Number Information
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NPI Number | 1568871002
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Entity Type | Organization
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Legal Business Name | LANDRUM BLOCKWOOD HOLDINGS CORPORATION
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Dates
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Enumeration Date | 08/08/2014
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Last Update Date | 08/18/2014
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Provider Practice Location Address
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Address Line | 966 N GARDEN RIDGE BLVD SUITE 500
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City | LEWISVILLE
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State | TX
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Zip | 75077-2827
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Country | US
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Telephone | 469-387-9632
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Fax |
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Provider Business Mailing Address
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Address Line | 4309 MILLINGTON DR
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City | HIGHLAND VILLAGE
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State | TX
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Zip | 75077-7913
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Country | US
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Telephone | 469-387-9632
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Fax |
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Authorized Official
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Title or Position | OWNER/ADMINISTRATOR
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Name | MR. KENNETH JAMES GREEN
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Credential |
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Telephone | 469-387-9632
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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