Provider Demographics
NPI:1790065845
Name:TEXAS KIDS HOME THERAPY PROFESSIONAL LIMITED LIABILITY COMPANY
Entity Type:Organization
Organization Name:TEXAS KIDS HOME THERAPY PROFESSIONAL LIMITED LIABILITY COMPANY
Other - Org Name:TEXAS KIDS HOME THERAY AND NURSING PROFESSIONAL LIMITED LIABILITY COMP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ALTERNATE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DERSHIE
Authorized Official - Middle Name:BRIDGFORD
Authorized Official - Last Name:KURTZ
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:210-274-6676
Mailing Address - Street 1:555 PRADO XING
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-8260
Mailing Address - Country:US
Mailing Address - Phone:210-360-1662
Mailing Address - Fax:210-568-2228
Practice Address - Street 1:7 UPPER BALCONES RD
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-8546
Practice Address - Country:US
Practice Address - Phone:210-360-1662
Practice Address - Fax:210-568-2228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-21
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
TX014370251J00000X, 3747P1801X, 385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing CareGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No385H00000XRespite Care FacilityRespite Care