Provider Demographics
NPI:1659686368
Name:A C KERV HEALTHCARE AGENCY
Entity Type:Organization
Organization Name:A C KERV HEALTHCARE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CNA/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:TYLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-709-3801
Mailing Address - Street 1:8004 W VIRGINIA DR
Mailing Address - Street 2:SUITE 207
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75237-4420
Mailing Address - Country:US
Mailing Address - Phone:972-709-3801
Mailing Address - Fax:
Practice Address - Street 1:8004 W VIRGINIA DR
Practice Address - Street 2:SUITE 207
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237-4420
Practice Address - Country:US
Practice Address - Phone:972-709-3801
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-18
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXNA569267251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health