Medline Health Services

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

Legal business name

MEDLINE HEALTH SERVICES

Practice address

4542 Long Creek Dr
Fresno, TX 77545-6064

Phone

(832) 877-3806

NPI assigned

Oct 23, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Kenneth N Ukah

Title

Manager

Phone

(832) 877-3806

Specialties & licenses 3

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1287792000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1288051200000",
    "number": "1649570706",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4542 LONG CREEK DR",
            "city": "FRESNO",
            "state": "TX",
            "postal_code": "775456064",
            "telephone_number": "832-877-3806"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4542 LONG CREEK DR",
            "city": "FRESNO",
            "state": "TX",
            "postal_code": "775456064",
            "telephone_number": "832-877-3806"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDLINE HEALTH SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-23",
        "last_updated": "2010-10-26",
        "status": "A",
        "authorized_official_last_name": "UKAH",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "832-877-3806",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hannah Maria McGowan, RN
• Shana Delise McGowan, MS,RDN, LD
• McKenzie Enterprise LLC
• Cheryl E McNalley, WHCNP
• Medline EMS LLC
• Izela Mellado
• Annette Melvin
• Alvin Mena Cantero
• Terrance Menard, FNP
• Charity Mensah Des Bordes, NP

• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Fresno, TX
• Providers in Fresno, TX by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.