Provider Demographics
NPI:1467597203
Name:THE HOUSE THAT KERRY BUILT, THE CENTER FOR MEDICALLY FRAGILE CHILDREN,
Entity Type:Organization
Organization Name:THE HOUSE THAT KERRY BUILT, THE CENTER FOR MEDICALLY FRAGILE CHILDREN,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:LOFTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-672-6061
Mailing Address - Street 1:751 HICKORY ST
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79601-5005
Mailing Address - Country:US
Mailing Address - Phone:325-672-6061
Mailing Address - Fax:325-672-5023
Practice Address - Street 1:751 HICKORY ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-5005
Practice Address - Country:US
Practice Address - Phone:325-672-6061
Practice Address - Fax:325-672-5023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX006075251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
459421Medicare Oscar/Certification