{
"Npi": {
"NPI": "1346781713",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "KIDSCARE THERAPY OF COLORADO, LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "4201 SPRING VALLEY RD STE 600",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "DALLAS",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "75244-3631",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "866-919-3240",
"MailingAddressFaxNumber": "877-300-7394",
"FirstLinePracticeLocationAddress": "3801 E FLORIDA AVE STE 917",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "DENVER",
"PracticeLocationAddressStateName": "CO",
"PracticeLocationAddressPostalCode": "80210-2549",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "844-757-7450",
"PracticeLocationAddressFaxNumber": "855-715-3504",
"EnumerationDate": "03/17/2017",
"LastUpdateDate": "12/10/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "KASKAVAGE",
"AuthorizedOfficialFirstName": "KELLY",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "DIRECTOR OF COMPLIANCE",
"AuthorizedOfficialNamePrefix": "MS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "214-575-2999",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "251E00000X",
"TaxonomyName": "Home Health Agency",
"LicenseNumber": "000000",
"LicenseNumberStateCode": "CO",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}