Provider Demographics
NPI:1578396552
Name:CHARITY PURE LOVE HOME HEALTH AGENCY KB LLC
Entity type:Organization
Organization Name:CHARITY PURE LOVE HOME HEALTH AGENCY KB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRADLAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:945-296-9117
Mailing Address - Street 1:3923 HOMETOWN BLVD BLDG 7
Mailing Address - Street 2:
Mailing Address - City:HEARTLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75126-8004
Mailing Address - Country:US
Mailing Address - Phone:945-296-9117
Mailing Address - Fax:
Practice Address - Street 1:3923 HOMETOWN BLVD BLDG 7
Practice Address - Street 2:
Practice Address - City:HEARTLAND
Practice Address - State:TX
Practice Address - Zip Code:75126-8004
Practice Address - Country:US
Practice Address - Phone:682-384-9234
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-23
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health