=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982551198
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KASBA TWENTY-FOUR
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/16/2026
-----------------------------------------------------
Last Update Date | 03/16/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15813 BARTON RIDGE DR
-----------------------------------------------------
City | FORT WORTH
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76177-1619
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-964-9903
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15813 BARTON RIDGE DR
-----------------------------------------------------
City | FORT WORTH
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76177-1619
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-964-9903
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRINCIPAL OWNER
-----------------------------------------------------
Name | JEROME E LEWIS
-----------------------------------------------------
Credential | MBA
-----------------------------------------------------
Telephone | 469-964-9903
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------