Provider Demographics
NPI:1669886040
Name:CKD HOSPICE & PALLIATIVE CARE INC
Entity type:Organization
Organization Name:CKD HOSPICE & PALLIATIVE CARE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHIKETA
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:844-767-3931
Mailing Address - Street 1:1015 E DALLAS ST STE 2
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-2029
Mailing Address - Country:US
Mailing Address - Phone:844-767-3931
Mailing Address - Fax:817-704-3188
Practice Address - Street 1:1015 E DALLAS ST STE 2
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-2029
Practice Address - Country:US
Practice Address - Phone:844-767-3931
Practice Address - Fax:817-704-3188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-13
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251G00000X, 3747A0650X
TX016517251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Multi-Specialty
No251G00000XAgenciesHospice Care, Community Based
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Multi-Specialty