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NPI Code Detail

MEDICARE: KIDSCARE HOME HEALTH OF SOUTH CAROLINA, LLC

MEDICARE: KIDSCARE HOME HEALTH OF SOUTH CAROLINA, 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
1251E00000XHome Health Agency

General Provider Information

NPI Number : 1942952932
Entity Type Code : Organization
Provider Name (Legal Business Name) : KIDSCARE HOME HEALTH OF SOUTH CAROLINA, LLC
Provider Business Mailing Address
First Line : 4201 SPRING VALLEY RD STE 600
Second Line :
City : DALLAS
State : TX
Zip : 75244-3631
Country : US
Telephone Number : 866-919-3240
Fax Number : 877-300-7394
Provider Business Practice Location Address
First Line : 4105 FABER PLACE DR STE 420
Second Line :
City : NORTH CHARLESTON
State : SC
Zip : 29405-8594
Country : US
Telephone Number : 843-894-7347
Fax Number : 843-278-8599
Authorized Official
Title or Position : DIRECTOR OF COMPLIANCE
Name : KELLY KASKAVAGE
Credential :
Telephone Number : 214-575-2999
Provider Enumeration Date : 01/21/2022
Last Update Date : 12/10/2024

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