MEDICARE: KS HEALTHCARE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251G00000X	Community Based Hospice Care Agency

General Provider Information

NPI Number	:	1477214252
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KS HEALTHCARE

Provider Business Mailing Address
First Line	:	PO BOX 3034
Second Line	:
City	:	COLORADO CITY
State	:	AZ
Zip	:	86021-3034
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	60 N CENTRAL ST
Second Line	:
City	:	COLORADO CITY
State	:	AZ
Zip	:	86021-6134
Country	:	US
Telephone Number	:	801-318-1420
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MAHOGANI MADRIGAL
Credential	:
Telephone Number	:	801-318-1420

Provider Enumeration Date	:	01/04/2022
Last Update Date	:	01/04/2022

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Directions to “KS HEALTHCARE ” Practice Location

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