Organization
MEDLINE HEALTH SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KENNETH N UKAH (MANAGER)
(832) 877-3806
Entity
Organization
Contact information
Practice address
4542 LONG CREEK DR, FRESNO, TX 77545-6064
(832) 877-3806
Mailing address
4542 LONG CREEK DR, FRESNO, TX 77545-6064
(832) 877-3806
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
253Z00000X
In Home Supportive Care Agency
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
10/23/2010
Last updated
10/26/2010
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