Provider Demographics
NPI:1467687475
Name:KYNDAL KARE
Entity Type:Organization
Organization Name:KYNDAL KARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DERICK
Authorized Official - Middle Name:D
Authorized Official - Last Name:WATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:318-949-9999
Mailing Address - Street 1:794 PEGUES RD
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75603-6616
Mailing Address - Country:US
Mailing Address - Phone:903-643-8638
Mailing Address - Fax:
Practice Address - Street 1:794 PEGUES RD
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75603-6616
Practice Address - Country:US
Practice Address - Phone:903-261-7386
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-19
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities