Provider Demographics
NPI:1841869096
Name:KIDSCARE HOME HEALTH OF VIRGINIA LLC
Entity type:Organization
Organization Name:KIDSCARE HOME HEALTH OF VIRGINIA LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF COMPLIANCE
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:KASKAVAGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-575-2999
Mailing Address - Street 1:4201 SPRING VALLEY RD STE 600
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75244-3631
Mailing Address - Country:US
Mailing Address - Phone:866-919-3240
Mailing Address - Fax:
Practice Address - Street 1:1768 BUSINESS CENTER DR STE 330
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5349
Practice Address - Country:US
Practice Address - Phone:866-919-3240
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-22
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care