Healthcare Provider Details

I. General information

NPI: 1164136727
Provider Name (Legal Business Name): KIDSCARE HOME HEALTH OF MARYLAND, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2023
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1122 KENILWORTH DR STE 501A
TOWSON MD
21204-2191
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: 800-803-8356
Mailing address:
  • Phone: 866-919-3240
  • Fax: 877-300-7394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier423385900
Identifier TypeMEDICAID
Identifier StateMD
Identifier Issuer

VIII. Authorized Official

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