Provider Demographics
NPI:1609933373
Name:KINETICARE REHAB SERVICES P.C.
Entity Type:Organization
Organization Name:KINETICARE REHAB SERVICES P.C.
Other - Org Name:REHAB AT HOME HEALTHCARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DON, ALTERNATE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:VICTORIA
Authorized Official - Last Name:HART
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:817-469-9756
Mailing Address - Street 1:2301 W LAMAR BLVD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76012-5669
Mailing Address - Country:US
Mailing Address - Phone:817-469-9756
Mailing Address - Fax:817-469-9758
Practice Address - Street 1:2301 W LAMAR BLVD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-5669
Practice Address - Country:US
Practice Address - Phone:817-469-9756
Practice Address - Fax:817-469-9758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008308251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX170871101Medicaid
TX170871101Medicaid