Provider Demographics
NPI:1114382975
Name:KASS
Entity Type:Organization
Organization Name:KASS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:STRAWTHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-451-6413
Mailing Address - Street 1:2817 STARK STREET
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76112
Mailing Address - Country:US
Mailing Address - Phone:817-451-6413
Mailing Address - Fax:817-451-7712
Practice Address - Street 1:2817 STARK ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76112-6562
Practice Address - Country:US
Practice Address - Phone:817-451-6413
Practice Address - Fax:817-451-7712
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KASS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-12-22
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX454812261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)