MEDICARE: ABOUT KIDS HOME CARE NORTH 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	251E00000X	Home Health Agency

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	O4E516	OTHER		MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316542806
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABOUT KIDS HOME CARE NORTH LLC

Provider Business Mailing Address
First Line	:	16270 FOREST LIGHT DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80908-2074
Country	:	US
Telephone Number	:	719-644-1119
Fax Number	:	303-223-0084

Provider Business Practice Location Address
First Line	:	200 W CITY CENTER DR STE 200A
Second Line	:
City	:	PUEBLO
State	:	CO
Zip	:	81003-1024
Country	:	US
Telephone Number	:	719-387-7775
Fax Number	:	303-223-0084

Authorized Official
Title or Position	:	OWNER/MEMBER/CEO
Name	:	JASON PICKERILL
Credential	:
Telephone Number	:	719-644-1119

Provider Enumeration Date	:	12/02/2020
Last Update Date	:	11/04/2024

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Directions to “ABOUT KIDS HOME CARE NORTH LLC ” Practice Location

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