Provider Demographics
NPI:1376631952
Name:KEMG HOME HEALTH CARE INC
Entity type:Organization
Organization Name:KEMG HOME HEALTH CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLANUEVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-262-4300
Mailing Address - Street 1:810 DALWORTH ST STE A
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75050-5545
Mailing Address - Country:US
Mailing Address - Phone:972-262-4300
Mailing Address - Fax:972-262-4302
Practice Address - Street 1:810A DALWORTH ST STE A
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75050-5545
Practice Address - Country:US
Practice Address - Phone:972-262-4300
Practice Address - Fax:972-262-4302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2019-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX011359251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3188385Medicaid
TX457999Medicare ID - Type UnspecifiedHOME HEALTH AGENCY