Healthcare Provider Details

I. General information

NPI: 1740198159
Provider Name (Legal Business Name): KSC CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13827 N 41ST PL
PHOENIX AZ
85032-5815
US

IV. Provider business mailing address

1413 E MULBERRY ST
PHOENIX AZ
85014-5663
US

V. Phone/Fax

Practice location:
  • Phone: 602-803-9575
  • Fax:
Mailing address:
  • Phone: 602-803-9575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number
License Number State

VIII. Authorized Official

Name: RUSLAN RAZINN
Title or Position: OWNER/OPERATOR
Credential:
Phone: 602-803-9575