=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174576672
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KC'S HOME HEALTHCARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/18/2006
-----------------------------------------------------
Last Update Date | 02/18/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 20612 N CAVE CREEK RD # F151
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85024-4440
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-283-4089
-----------------------------------------------------
Fax | 602-283-4498
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 20612 N CAVE CREEK RD # F151
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85024-4440
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-283-4089
-----------------------------------------------------
Fax | 602-283-4498
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/CEO
-----------------------------------------------------
Name | MR. KERRY ALLEN HALCOMB
-----------------------------------------------------
Credential | P.T.
-----------------------------------------------------
Telephone | 602-283-4089
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------