MEDICARE: KAIROS HEALTH SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency	R102836	MD

General Provider Information

NPI Number	:	1275830085
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KAIROS HEALTH SERVICES, LLC

Provider Business Mailing Address
First Line	:	7100 PLYMOUTH RD
Second Line	:
City	:	PIKESVILLE
State	:	MD
Zip	:	21208-6033
Country	:	US
Telephone Number	:	410-365-9662
Fax Number	:	410-580-0173

Provider Business Practice Location Address
First Line	:	7100 PLYMOUTH RD
Second Line	:
City	:	PIKESVILLE
State	:	MD
Zip	:	21208-6033
Country	:	US
Telephone Number	:	410-365-9662
Fax Number	:	410-580-0173

Authorized Official
Title or Position	:	DIRECTOR OF NURSING/ OWNER
Name	:	MS. ROCHELLE DENE PURNELL
Credential	:	RN
Telephone Number	:	410-365-9662

Provider Enumeration Date	:	02/15/2011
Last Update Date	:	02/15/2011

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