Provider Demographics
NPI:1871745547
Name:KAI HEART HOME HEALTH CARE
Entity type:Organization
Organization Name:KAI HEART HOME HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-689-8982
Mailing Address - Street 1:1720 REGAL ROW
Mailing Address - Street 2:SUITE 235
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-2299
Mailing Address - Country:US
Mailing Address - Phone:214-689-8982
Mailing Address - Fax:
Practice Address - Street 1:1720 REGAL ROW
Practice Address - Street 2:SUITE 235
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-2299
Practice Address - Country:US
Practice Address - Phone:214-689-8982
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-14
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX005743251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001003899Medicaid
TX024408903Medicaid
TX001003899Medicaid