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General NPI Number Information
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NPI Number | 1841952132
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Entity Type | Organization
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Legal Business Name | KOROHEKE CARE, LLC
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Dates
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Enumeration Date | 10/13/2021
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Last Update Date | 09/12/2023
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Provider Practice Location Address
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Address Line | 3701 SANGUINET ST STE 107
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City | FORT WORTH
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State | TX
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Zip | 76107-6827
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Country | US
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Telephone | 682-348-9785
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 24
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City | ROANOKE
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State | TX
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Zip | 76262-0024
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Country | US
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Telephone | 714-588-7873
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF CONTRACT PROCUREMENT
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Name | RUTH HERRERA
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Credential |
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Telephone | 714-588-7873
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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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Taxonomy #2
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Taxonomy Code | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number |
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License Number State |
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