Provider Demographics
NPI:1821399403
Name:KESHA LASHA PHILLIPS
Entity Type:Organization
Organization Name:KESHA LASHA PHILLIPS
Other - Org Name:EMBRACING ANGELS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KESHA
Authorized Official - Middle Name:LASHA
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-739-7894
Mailing Address - Street 1:PO BOX 1185
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77879-1185
Mailing Address - Country:US
Mailing Address - Phone:979-739-7894
Mailing Address - Fax:
Practice Address - Street 1:2195 TAYLOR RD
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:TX
Practice Address - Zip Code:77879-1185
Practice Address - Country:US
Practice Address - Phone:979-739-7894
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-12
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities