Provider Demographics
NPI:1750781217
Name:KINSHIP PLACE
Entity type:Organization
Organization Name:KINSHIP PLACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KEARY
Authorized Official - Middle Name:
Authorized Official - Last Name:ATKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:817-298-6533
Mailing Address - Street 1:4436 ARBORWOOD TRL
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76123-2730
Mailing Address - Country:US
Mailing Address - Phone:817-298-6533
Mailing Address - Fax:817-297-1371
Practice Address - Street 1:4304 PECOS ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76119-5162
Practice Address - Country:US
Practice Address - Phone:817-810-8193
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-02
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0800XAmbulatory Health Care FacilitiesClinic/CenterRecovery Care
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home