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	1150664	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	:	1699842831
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	:	512-658-5959
Fax Number	:	512-336-0812

Provider Business Practice Location Address
First Line	:	2402 BERNARD ST
Second Line	:
City	:	DENTON
State	:	TX
Zip	:	76205-5848
Country	:	US
Telephone Number	:	940-566-4961
Fax Number	:	940-566-2371

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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Directions to “KENMAR RESIDENTIAL SERVICES, INCORPORATED ” Practice Location

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