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NPI Code Detail

MEDICARE: KENMAR RESIDENTIAL SERVICES, INCORPORATED

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
1320900000XIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility115078TX

Other Identifiers

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

General Provider Information

NPI Number : 1700953916
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 : 3110 BUFFALO GAP RD
Second Line :
City : ABILENE
State : TX
Zip : 79605-6810
Country : US
Telephone Number : 325-691-0810
Fax Number : 325-691-1817
Authorized Official
Title or Position : EVP
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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