Provider Demographics
NPI:1346578770
Name:KONEKTZ LLC
Entity Type:Organization
Organization Name:KONEKTZ LLC
Other - Org Name:1ST HERITAGE WAY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VICKY
Authorized Official - Middle Name:
Authorized Official - Last Name:FEMI-MICHAELS
Authorized Official - Suffix:
Authorized Official - Credentials:BA, PGD
Authorized Official - Phone:972-699-7700
Mailing Address - Street 1:13521 METHOD ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-1409
Mailing Address - Country:US
Mailing Address - Phone:972-699-7700
Mailing Address - Fax:214-452-9938
Practice Address - Street 1:13521 METHOD ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-1409
Practice Address - Country:US
Practice Address - Phone:972-699-7700
Practice Address - Fax:214-452-9938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-23
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX128040311500000X, 311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)