Provider Demographics
NPI:1275836918
Name:KDC HEALTHCARE PARTNERS
Entity Type:Organization
Organization Name:KDC HEALTHCARE PARTNERS
Other - Org Name:HERITAGE HOME HEALTH OF EAST TEXAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:STAYTON
Authorized Official - Last Name:CLEMENS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:903-792-0716
Mailing Address - Street 1:4605 TEXAS BLVD
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-3028
Mailing Address - Country:US
Mailing Address - Phone:903-792-0716
Mailing Address - Fax:903-792-0719
Practice Address - Street 1:1330 CHURCH ST
Practice Address - Street 2:
Practice Address - City:SULPHUR SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:75482-2161
Practice Address - Country:US
Practice Address - Phone:888-466-3016
Practice Address - Fax:888-702-7991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-20
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX020457OtherTEXAS HEALTH AND HUMAN SERVICES COMMISION
TX677893OtherMEDICARE/PALMETTO PTAN