Provider Demographics
NPI:1407627151
Name:KIWICARE NON MEDICAL HOMECARE AGENCY
Entity Type:Organization
Organization Name:KIWICARE NON MEDICAL HOMECARE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JACQUI
Authorized Official - Middle Name:SUSAN
Authorized Official - Last Name:TAASE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-284-3908
Mailing Address - Street 1:5100 RONALD REAGAN BLVD APT E303
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:CO
Mailing Address - Zip Code:80534-6482
Mailing Address - Country:US
Mailing Address - Phone:832-284-3908
Mailing Address - Fax:
Practice Address - Street 1:390 INTERLOCKEN BOULEVARD SUITE 350
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80021
Practice Address - Country:US
Practice Address - Phone:832-284-3908
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-11
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care