Healthcare Provider Details

I. General information

NPI: 1205446135
Provider Name (Legal Business Name): KIDSCARE HOME HEALTH OF OREGON LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2020
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8625 SW CASCADE AVE
BEAVERTON OR
97008-7121
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 877-755-8940
  • Fax:
Mailing address:
  • Phone: 866-919-3240
  • Fax:

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