MEDICARE: THOMAS NICHOLAS KANDRAVY

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	3747P1801X	Personal Care Attendant	CO
2	372500000X	Chore Provider	CO
3	372600000X	Adult Companion	CO
4	3747A0650X	Attendant Care Provider	CO
5	376J00000X	Homemaker	CO

General Provider Information

NPI Number	:	1689184707
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS NICHOLAS KANDRAVY

Provider Business Mailing Address
First Line	:	5800 TOWER RD APT 210
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80249-8418
Country	:	US
Telephone Number	:	720-534-0550
Fax Number	:	720-302-2111

Provider Business Practice Location Address
First Line	:	5800 TOWER RD APT 210
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80249-8418
Country	:	US
Telephone Number	:	720-534-0550
Fax Number	:	720-302-2111

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2017
Last Update Date	:	06/16/2018

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