Provider Demographics
NPI:1962920389
Name:KQ NETS
Entity type:Organization
Organization Name:KQ NETS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WALLACE
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:281-683-5053
Mailing Address - Street 1:PO BOX 550305
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77255-0305
Mailing Address - Country:US
Mailing Address - Phone:281-683-5053
Mailing Address - Fax:
Practice Address - Street 1:7981 LITTLE STREET
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77028
Practice Address - Country:US
Practice Address - Phone:281-683-5053
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KINSLEY QUEEN INCORPORATED
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-09-06
Last Update Date:2017-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251E00000X
251S00000X, 252Y00000X, 310400000X, 343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No251E00000XAgenciesHome Health
No251S00000XAgenciesCommunity/Behavioral Health
No252Y00000XAgenciesEarly Intervention Provider Agency
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1407157860Medicaid