Provider Demographics
NPI:1174823330
Name:KGBELLOS RESIDENTIAL CARE, INC.
Entity Type:Organization
Organization Name:KGBELLOS RESIDENTIAL CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ONYEKACHI
Authorized Official - Middle Name:
Authorized Official - Last Name:OKORO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-253-7486
Mailing Address - Street 1:2015 VISTA DR
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-7474
Mailing Address - Country:US
Mailing Address - Phone:214-253-7486
Mailing Address - Fax:214-488-5983
Practice Address - Street 1:2015 VISTA DR
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-7474
Practice Address - Country:US
Practice Address - Phone:214-253-7486
Practice Address - Fax:214-488-5983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-21
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX014332251E00000X
311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home