Provider Demographics
NPI:1518168483
Name:KENWELL HOME
Entity Type:Organization
Organization Name:KENWELL HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HOME ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:GROOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-904-1734
Mailing Address - Street 1:6614 KENWELL ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75209-5344
Mailing Address - Country:US
Mailing Address - Phone:214-904-1734
Mailing Address - Fax:
Practice Address - Street 1:6614 KENWELL ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75209-5344
Practice Address - Country:US
Practice Address - Phone:214-904-1734
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities