Provider Demographics
NPI:1164775169
Name:KC'S HOME HEALTH CARE LLC OF PAYSON
Entity Type:Organization
Organization Name:KC'S HOME HEALTH CARE LLC OF PAYSON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:HALCOMB
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:1928-468-5242
Mailing Address - Street 1:114 E. HIGHWAY 260
Mailing Address - Street 2:
Mailing Address - City:PAYSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85541
Mailing Address - Country:US
Mailing Address - Phone:192-846-8524
Mailing Address - Fax:192-846-8524
Practice Address - Street 1:114 E. HIGHWAY 260
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:AZ
Practice Address - Zip Code:85541
Practice Address - Country:US
Practice Address - Phone:192-846-8524
Practice Address - Fax:192-846-8524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-16
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health