MEDICARE: KENMAR RESIDENTIAL SERVICES, INCORPORATED

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	118749	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023185246
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KENMAR RESIDENTIAL SERVICES, INCORPORATED

Provider Business Mailing Address
First Line	:	33 CYPRESS BLVD STE 100
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78665-1006
Country	:	US
Telephone Number	:	512-336-0800
Fax Number	:	512-336-0812

Provider Business Practice Location Address
First Line	:	11101 BLUFF CANYON DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78754-2001
Country	:	US
Telephone Number	:	512-336-0800
Fax Number	:	512-336-0812

Authorized Official
Title or Position	:	EXECUTIVE VICE PRESIDENT
Name	:	AMANDA PEAKES-TAYLOR
Credential	:
Telephone Number	:	713-927-9920

Provider Enumeration Date	:	11/30/2006
Last Update Date	:	12/03/2025

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