MEDICARE: K & K LIVING CENTER, 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	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	0000H08KC	TX
2	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility	000738701/ 000759701	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730135161
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	K & K LIVING CENTER, INC

Provider Business Mailing Address
First Line	:	PO BOX 842679
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77284-2679
Country	:	US
Telephone Number	:	281-859-9474
Fax Number	:	281-859-8037

Provider Business Practice Location Address
First Line	:	16802 JUDYLEIGH DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77084-1949
Country	:	US
Telephone Number	:	281-859-9474
Fax Number	:	281-859-8037

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. DONNIE H MCGRAW
Credential	:
Telephone Number	:	281-859-9474

Provider Enumeration Date	:	05/26/2006
Last Update Date	:	04/11/2011

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Directions to “K & K LIVING CENTER, INC ” Practice Location

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