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General NPI Number Information
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NPI Number | 1720391014
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Entity Type | Organization
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Legal Business Name | KADIEKARE COMPANION HOME CARE
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Dates
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Enumeration Date | 07/15/2010
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Last Update Date | 07/15/2010
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Provider Practice Location Address
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Address Line | 2828 FOREST LN STE 1011
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City | DALLAS
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State | TX
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Zip | 75234-7570
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Country | US
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Telephone | 972-484-2626
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Fax | 972-853-7410
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Provider Business Mailing Address
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Address Line | 2828 FOREST LN STE 1011
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City | DALLAS
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State | TX
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Zip | 75234-7570
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Country | US
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Telephone | 972-484-2626
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Fax | 972-853-7410
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Authorized Official
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Title or Position | EXECUTIVE ADMINISTRATOR
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Name | MR. ISAAC A PRINCE
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Credential |
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Telephone | 972-877-2211
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343800000X
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Taxonomy Name | Secured Medical Transport (VAN)
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License Number | 02334972
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License Number State | TX
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