Provider Demographics
NPI:1326068859
Name:KAN HEALTHCARE AGENCY, INC.
Entity Type:Organization
Organization Name:KAN HEALTHCARE AGENCY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR NURSING SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANTHONIA
Authorized Official - Middle Name:UCHE
Authorized Official - Last Name:AZUBOGU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-744-0111
Mailing Address - Street 1:661 N PLANO RD
Mailing Address - Street 2:SUITE #319
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-2960
Mailing Address - Country:US
Mailing Address - Phone:214-564-5600
Mailing Address - Fax:972-744-0116
Practice Address - Street 1:661 N PLANO RD
Practice Address - Street 2:SUITE #319
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-2960
Practice Address - Country:US
Practice Address - Phone:214-564-5600
Practice Address - Fax:972-744-0116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX74-3102Medicare PIN