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General NPI Number Information
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NPI Number | 1720754450
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Entity Type | Organization
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Legal Business Name | KASSIDY KARE HOME AGENCY
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Dates
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Enumeration Date | 08/22/2021
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Last Update Date | 10/12/2021
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Provider Practice Location Address
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Address Line | 7629 BRAMBLEWOOD DR APT SUITE
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City | PORT RICHEY
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State | FL
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Zip | 34668-7009
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Country | US
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Telephone | 850-901-7004
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Fax |
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Provider Business Mailing Address
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Address Line | 7629 BRAMBLEWOOD DR
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City | PORT RICHEY
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State | FL
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Zip | 34668-7009
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Country | US
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Telephone | 772-242-3596
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | MISS CICELY MASON
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Credential |
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Telephone | 772-242-3596
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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