Provider Demographics
NPI:1609519636
Name:KELO COMMUNITY HUMAN SERVICES
Entity Type:Organization
Organization Name:KELO COMMUNITY HUMAN SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:AZIRENO
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:TOBI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-590-2243
Mailing Address - Street 1:10923 DERMOTT RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77406-5295
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10923 DERMOTT RIDGE DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77406-5295
Practice Address - Country:US
Practice Address - Phone:617-590-2243
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-18
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)