Provider Demographics
NPI:1174817126
Name:KS GIFTED SERVICES
Entity Type:Organization
Organization Name:KS GIFTED SERVICES
Other - Org Name:KS GIFTED SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEISHA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:FERGUSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-637-2362
Mailing Address - Street 1:111 S SPRING CREEK DR
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-4713
Mailing Address - Country:US
Mailing Address - Phone:817-637-2362
Mailing Address - Fax:
Practice Address - Street 1:111 S SPRING CREEK DR
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-4713
Practice Address - Country:US
Practice Address - Phone:817-637-2362
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-07
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization