Provider Demographics
NPI:1316542806
Name:ABOUT KIDS HOME CARE NORTH LLC
Entity Type:Organization
Organization Name:ABOUT KIDS HOME CARE NORTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:PICKERILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-644-1119
Mailing Address - Street 1:16270 FOREST LIGHT DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80908-2074
Mailing Address - Country:US
Mailing Address - Phone:719-644-1119
Mailing Address - Fax:303-223-0084
Practice Address - Street 1:16270 FOREST LIGHT DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80908-2074
Practice Address - Country:US
Practice Address - Phone:719-644-1119
Practice Address - Fax:303-223-0084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-02
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
COO4E516Medicaid