Provider Demographics
NPI:1619104668
Name:KINGWOOD PERSONAL ASSISTANCE, LLC
Entity Type:Organization
Organization Name:KINGWOOD PERSONAL ASSISTANCE, LLC
Other - Org Name:GENERIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:REDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-913-2512
Mailing Address - Street 1:2807 KINGS CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77345-5450
Mailing Address - Country:US
Mailing Address - Phone:281-913-2512
Mailing Address - Fax:281-361-5745
Practice Address - Street 1:2807 KINGS CROSSING DR
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77345-5450
Practice Address - Country:US
Practice Address - Phone:281-913-2512
Practice Address - Fax:281-361-5745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-17
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care