MEDICARE: CK TEXAS HOLDINGS INC.

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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1043892706
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CK TEXAS HOLDINGS INC.

Provider Business Mailing Address
First Line	:	8205 CAMP BOWIE WEST BLVD STE 216
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76116-6328
Country	:	US
Telephone Number	:	817-560-8085
Fax Number	:	817-560-7760

Provider Business Practice Location Address
First Line	:	8205 CAMP BOWIE WEST BLVD STE 216
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76116-6328
Country	:	US
Telephone Number	:	817-560-8085
Fax Number	:	817-560-7760

Authorized Official
Title or Position	:	PRESIDENT/ADMINISTRATOR
Name	:	MR. SCOTT RYAN VAN DUINEN
Credential	:
Telephone Number	:	817-560-8085

Provider Enumeration Date	:	04/22/2021
Last Update Date	:	04/22/2021

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