Provider Demographics
NPI:1689986911
Name:KDP HEALTH CARE SERVICES
Entity Type:Organization
Organization Name:KDP HEALTH CARE SERVICES
Other - Org Name:KDP HEALTH CARE SERVICES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DAISY
Authorized Official - Middle Name:EVETTE
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:01181967
Authorized Official - Phone:832-891-4952
Mailing Address - Street 1:11338 SAGEHILL DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77089-4634
Mailing Address - Country:US
Mailing Address - Phone:832-891-4952
Mailing Address - Fax:
Practice Address - Street 1:11338 SAGE HILL DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77089-4634
Practice Address - Country:US
Practice Address - Phone:832-891-4952
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KDP HEALTH CARE SERVIICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-07-01
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXW13557302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization