Provider Demographics
NPI:1699319012
Name:KENMAR RESIDENTIAL SERVICES
Entity type:Organization
Organization Name:KENMAR RESIDENTIAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:BERNADETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:BACHELORS OF SCIENCE
Authorized Official - Phone:512-336-0800
Mailing Address - Street 1:33 CYPRESS BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78665-1006
Mailing Address - Country:US
Mailing Address - Phone:512-658-5959
Mailing Address - Fax:512-336-0812
Practice Address - Street 1:124 MEADOW LN
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:TX
Practice Address - Zip Code:78945-1409
Practice Address - Country:US
Practice Address - Phone:512-658-5959
Practice Address - Fax:512-336-0812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-29
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310500000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Mental Illness