Provider Demographics
NPI:1720754450
Name:KASSIDY KARE HOME AGENCY
Entity Type:Organization
Organization Name:KASSIDY KARE HOME AGENCY
Other - Org Name:KASSIDY KARE HOME AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:CICELY
Authorized Official - Middle Name:
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-242-3596
Mailing Address - Street 1:7629 BRAMBLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34668-7009
Mailing Address - Country:US
Mailing Address - Phone:772-242-3596
Mailing Address - Fax:
Practice Address - Street 1:7629 BRAMBLEWOOD DR APT SUITE
Practice Address - Street 2:
Practice Address - City:PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34668-7009
Practice Address - Country:US
Practice Address - Phone:850-901-7004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-22
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251B00000XAgenciesCase Management
No251E00000XAgenciesHome Health