Provider Demographics
NPI:1679834568
Name:KMKG, LLC
Entity Type:Organization
Organization Name:KMKG, LLC
Other - Org Name:DJ HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KENYA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-326-1976
Mailing Address - Street 1:708 W 26TH ST
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77803-2428
Mailing Address - Country:US
Mailing Address - Phone:979-492-6448
Mailing Address - Fax:
Practice Address - Street 1:708 W 26TH ST
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77803-2428
Practice Address - Country:US
Practice Address - Phone:979-492-6448
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-06
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health