Provider Demographics
NPI:1265018444
Name:KENMAR RESIDENTIAL SERVICES
Entity Type:Organization
Organization Name:KENMAR RESIDENTIAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:V.P. OF OPERATION
Authorized Official - Prefix:MRS
Authorized Official - First Name:BERNADETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-336-0800
Mailing Address - Street 1:33 CYPRESS BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78665-1006
Mailing Address - Country:US
Mailing Address - Phone:512-658-5959
Mailing Address - Fax:
Practice Address - Street 1:HIRSCH SCHWARTZ COMMUNITY RESIDENCE
Practice Address - Street 2:2021 W. US HWY. 90
Practice Address - City:SCHULENBURG
Practice Address - State:TX
Practice Address - Zip Code:78956
Practice Address - Country:US
Practice Address - Phone:979-968-8820
Practice Address - Fax:979-968-6598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-19
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities