Healthcare Provider Details

I. General information

NPI: 1831852219
Provider Name (Legal Business Name): KC CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2021
Last Update Date: 10/21/2021
Certification Date: 10/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 15TH ST SE STE 202
PUYALLUP WA
98372-3796
US

IV. Provider business mailing address

120 15TH ST SE STE 202
PUYALLUP WA
98372-3796
US

V. Phone/Fax

Practice location:
  • Phone: 253-251-5050
  • Fax: 253-251-5051
Mailing address:
  • Phone: 253-251-5050
  • Fax: 253-251-5051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State

VIII. Authorized Official

Name: KATIE JONES
Title or Position: OWNER, DON
Credential: RN, MSN
Phone: 253-251-5050