Provider Demographics
NPI:1659008423
Name:KUPENDA HEALTHCARE SERVICES
Entity Type:Organization
Organization Name:KUPENDA HEALTHCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DA'SHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-534-2710
Mailing Address - Street 1:16006 RUSTIC SANDS DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-2957
Mailing Address - Country:US
Mailing Address - Phone:562-534-2710
Mailing Address - Fax:
Practice Address - Street 1:16006 RUSTIC SANDS DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77084-2957
Practice Address - Country:US
Practice Address - Phone:562-534-2710
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KUPENDA HEALTHCARE SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-08-02
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health