Provider Demographics
NPI:1326815770
Name:KESI CARE SERVICES LLC
Entity Type:Organization
Organization Name:KESI CARE SERVICES LLC
Other - Org Name:KONSE KONSE LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:MAGOMBO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-269-5633
Mailing Address - Street 1:1909 LEADERS LN # A
Mailing Address - Street 2:
Mailing Address - City:LEANDER
Mailing Address - State:TX
Mailing Address - Zip Code:78641-3142
Mailing Address - Country:US
Mailing Address - Phone:512-269-5633
Mailing Address - Fax:
Practice Address - Street 1:1909 LEADERS LN
Practice Address - Street 2:
Practice Address - City:LEANDER
Practice Address - State:TX
Practice Address - Zip Code:78641-3142
Practice Address - Country:US
Practice Address - Phone:512-269-5633
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-06
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty