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General NPI Number Information
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NPI Number | 1952128654
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Entity Type | Organization
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Legal Business Name | KELLEY'S KARING TOUCH, LLC
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Dates
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Enumeration Date | 09/24/2024
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Last Update Date | 09/25/2024
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Provider Practice Location Address
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Address Line | 2750 HIGHWAY 12
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City | VIDOR
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State | TX
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Zip | 77662-3435
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Country | US
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Telephone | 409-659-7306
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Fax | 409-422-0050
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Provider Business Mailing Address
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Address Line | 2750 HIGHWAY 12
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City | VIDOR
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State | TX
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Zip | 77662-3435
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Country | US
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Telephone | 409-659-7306
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Fax | 409-422-0050
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | MRS. MATILDA DENISE KELLEY
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Credential | BSN, RN, CLT
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Telephone | 409-659-7306
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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