MEDICARE: FOR THE KIDS SERVICES

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	A-5388	NC
2	253Z00000X	In Home Supportive Care Agency	RCP 3381	SC

General Provider Information

NPI Number	:	1457505935
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOR THE KIDS SERVICES

Provider Business Mailing Address
First Line	:	4746 CASCADE AVE
Second Line	:
City	:	ROCK HILL
State	:	SC
Zip	:	29732-8190
Country	:	US
Telephone Number	:	803-207-9805
Fax Number	:

Provider Business Practice Location Address
First Line	:	4746 CASCADE AVE
Second Line	:
City	:	ROCK HILL
State	:	SC
Zip	:	29732-8190
Country	:	US
Telephone Number	:	803-207-9805
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ONTWAIN SIMPSON
Credential	:
Telephone Number	:	803-207-9805

Provider Enumeration Date	:	11/10/2008
Last Update Date	:	01/10/2011

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