Provider Demographics
NPI:1932596459
Name:KAIROS HOME CARE LLC
Entity Type:Organization
Organization Name:KAIROS HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/DPCS DESIGNEE
Authorized Official - Prefix:MS
Authorized Official - First Name:GINA RACHEL
Authorized Official - Middle Name:MANGUNAY
Authorized Official - Last Name:ROMERO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:510-303-9860
Mailing Address - Street 1:4510 PERALTA BLVD
Mailing Address - Street 2:#7
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94536-5755
Mailing Address - Country:US
Mailing Address - Phone:510-358-2271
Mailing Address - Fax:510-358-2278
Practice Address - Street 1:4510 PERALTA BLVD
Practice Address - Street 2:SUITE #7
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94536-5755
Practice Address - Country:US
Practice Address - Phone:510-358-2271
Practice Address - Fax:510-358-2278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-22
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA059758Medicare PIN