=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205446135
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KIDSCARE HOME HEALTH OF OREGON LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/05/2020
-----------------------------------------------------
Last Update Date | 12/10/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8625 SW CASCADE AVE
-----------------------------------------------------
City | BEAVERTON
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97008-7121
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 877-755-8940
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4201 SPRING VALLEY RD STE 600
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75244-3631
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 866-919-3240
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF COMPLIANCE
-----------------------------------------------------
Name | MS. KELLY KASKAVAGE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 214-575-2999
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------