Provider Demographics
NPI:1518928373
Name:HOME HEALTH SERVICES OF MASON KIMBLE & MENARD INC
Entity Type:Organization
Organization Name:HOME HEALTH SERVICES OF MASON KIMBLE & MENARD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN ADM
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:G
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-347-5145
Mailing Address - Street 1:717 E RAINEY ST
Mailing Address - Street 2:PO BOX 238
Mailing Address - City:MASON
Mailing Address - State:TX
Mailing Address - Zip Code:76856
Mailing Address - Country:US
Mailing Address - Phone:325-347-5145
Mailing Address - Fax:325-347-6916
Practice Address - Street 1:717 E RAINEY ST
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:TX
Practice Address - Zip Code:76856
Practice Address - Country:US
Practice Address - Phone:325-347-5145
Practice Address - Fax:325-347-6916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX002262251E00000X
TX001334251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXK06774589Medicaid
TXK06774589Medicaid