Healthcare Provider Details

I. General information

NPI: 1578278446
Provider Name (Legal Business Name): KIDSCARE HOME HEALTH OF WASHINGTON D.C., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2023
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3303 STANTON RD SE STE A
WASHINGTON DC
20020-2252
US

IV. Provider business mailing address

4201 SPRING VALLEY RD STE 600
DALLAS TX
75244-3631
US

V. Phone/Fax

Practice location:
  • Phone: 703-679-7837
  • Fax: 877-300-7394
Mailing address:
  • Phone: 866-919-3240
  • Fax: 877-300-7394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: KELLY KASKAVAGE
Title or Position: DIRECTOR OF COMPLIANCE
Credential:
Phone: 214-575-2999