Provider Demographics
NPI:1376061796
Name:KINSLEY QUEEN INC.
Entity Type:Organization
Organization Name:KINSLEY QUEEN INC.
Other - Org Name:KQ NETS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WALLACE
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:281-683-5053
Mailing Address - Street 1:PO BOX 550305
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77255-0305
Mailing Address - Country:US
Mailing Address - Phone:281-683-5053
Mailing Address - Fax:
Practice Address - Street 1:7981 LITTLE STREET
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77028
Practice Address - Country:US
Practice Address - Phone:281-683-5053
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-06
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111N00000X, 172V00000X, 225800000X, 310400000X, 347E00000X
TX23840944343900000X, 347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty
No225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation TherapistGroup - Multi-Specialty
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No347C00000XTransportation ServicesPrivate Vehicle
No347E00000XTransportation ServicesTransportation BrokerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1407157860OtherPRIVATE PAY
TX1407157860Medicaid