Provider Demographics
NPI:1164514006
Name:KC HEALTHCARE & REHABILITATION
Entity Type:Organization
Organization Name:KC HEALTHCARE & REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHUKA
Authorized Official - Middle Name:
Authorized Official - Last Name:ORAKPO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-781-2050
Mailing Address - Street 1:7100 REGENCY SQUARE BLVD
Mailing Address - Street 2:SUITE 248A
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-3202
Mailing Address - Country:US
Mailing Address - Phone:713-781-2050
Mailing Address - Fax:281-238-9812
Practice Address - Street 1:7100 REGENCY SQUARE BLVD
Practice Address - Street 2:SUITE 248A
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-3202
Practice Address - Country:US
Practice Address - Phone:713-781-2050
Practice Address - Fax:281-238-9812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
TX172605320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1726705Medicaid
TX00765XMedicare PIN