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General NPI Number Information
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NPI Number | 1629808274
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Entity Type | Organization
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Legal Business Name | LAKAYES GRACIOUS HOME HEALTH
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Dates
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Enumeration Date | 08/07/2024
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Last Update Date | 08/14/2024
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Provider Practice Location Address
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Address Line | 1807 TANGLEBERRY CT
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City | FRESNO
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State | TX
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Zip | 77545-7520
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Country | US
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Telephone | 832-986-2826
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1722
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City | TEXAS CITY
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State | TX
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Zip | 77592-1722
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Country | US
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Telephone | 832-986-2826
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TIMEKA KOTUN
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Credential |
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Telephone | 832-986-2826
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 343800000X
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Taxonomy Name | Secured Medical Transport (VAN)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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