Provider Demographics
NPI:1942818067
Name:KABBAGE PATCH GROUP HOMES
Entity Type:Organization
Organization Name:KABBAGE PATCH GROUP HOMES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ALT ADMIN/WELLNESS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHARDE
Authorized Official - Middle Name:DAWNTRESE
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:254-221-9222
Mailing Address - Street 1:601 MUSTANG TRL
Mailing Address - Street 2:
Mailing Address - City:HARKER HEIGHTS
Mailing Address - State:TX
Mailing Address - Zip Code:76548-2340
Mailing Address - Country:US
Mailing Address - Phone:254-221-9222
Mailing Address - Fax:
Practice Address - Street 1:601 MUSTANG TRL
Practice Address - Street 2:
Practice Address - City:HARKER HEIGHTS
Practice Address - State:TX
Practice Address - Zip Code:76548-2340
Practice Address - Country:US
Practice Address - Phone:254-221-9222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-15
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility