Healthcare Provider Details

I. General information

NPI: 1538235841
Provider Name (Legal Business Name): KIOWA HOME HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 06/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 W 12TH ST
EADS CO
81036
US

IV. Provider business mailing address

PO BOX 336
EADS CO
81036
US

V. Phone/Fax

Practice location:
  • Phone: 719-438-5765
  • Fax: 719-438-2010
Mailing address:
  • Phone: 719-438-5765
  • Fax: 719-438-2010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: SHANNON DIXON
Title or Position: CFO
Credential:
Phone: 719-438-5401