MEDICARE: KANAQUIJAHIA WELCH

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	:	1811754435
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KANAQUIJAHIA WELCH

Provider Business Mailing Address
First Line	:	13509 LBJ FWY STE 200
Second Line	:
City	:	GARLAND
State	:	TX
Zip	:	75041-4704
Country	:	US
Telephone Number	:	972-670-8422
Fax Number	:

Provider Business Practice Location Address
First Line	:	13509 LBJ FWY STE 200
Second Line	:
City	:	GARLAND
State	:	TX
Zip	:	75041-4704
Country	:	US
Telephone Number	:	972-670-8422
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/29/2024
Last Update Date	:	03/05/2024

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