Organization
21STCENTURY HOMECARE SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENNETH RAY JOHNSON JR. (CEO)
(832) 656-4391
Entity
Organization
Contact information
Practice address
6710 LINDALE MANOR CT, SPRING, TX 77379-8931
(832) 656-4391
Mailing address
440 BENMAR DR, 3053, HOUSTON, TX 77060-3165
(832) 326-8291
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103T00000X
—
TX
Enumeration date
04/14/2014
Last updated
04/14/2014
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