NPIMap

Organization Active NPI

Kidscare Home Health of Maryland, LLC

  • Home Health Agency
  • Towson, MD
National Provider Identifier
1700293784
Registry record updated Dec 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
KIDSCARE HOME HEALTH OF MARYLAND, LLC
Practice address
1122 Kenilworth Dr Ste 501a
Towson, MD 21204-2191
Phone
(703) 679-7837
Fax
(800) 803-8356
NPI assigned
Jul 22, 2014
Last updated
Dec 10, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 10, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kelly Kaskavage
Title
Director of Compliance
Phone
(214) 575-2999

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X NU Primary

Addresses

Primary practice location

1122 Kenilworth Dr Ste 501a
Towson, MD 21204-2191

Mailing address

4201 Spring Valley Rd Ste 600
Dallas, TX 75244-3631
Phone (866) 919-3240

Other identifiers 1

IdentifierTypeStateIssuer
107543861MedicaidMD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20141121000696 MD Part A Provider - Home Health Agency 9638391907 Practice locations: Towson, MD

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1700293784. Details of each certification follow.

Home health agency certification: CCN 217161

Legal name
KIDSCARE HOME HEALTH OF MARYLAND, LLC
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Aug 3, 2010
Last certification
Feb 11, 2019
Ownership / control type
Proprietary
Organization structure
LLCProprietary
Incorporated
May 12, 2014 in MD
Enrollment address
1122 Kenilworth Dr
Ste 501a
Towson, MD 21204-2191

Care Compare: Home health agency

Medicare Care Compare
Listed as
Kidscare Home Health of Maryland, LLCCCN 217161 · All quality measures
Ownership
Proprietary
Certified
Aug 3, 2010
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

National Provider Directory

National Provider Directory
Tax ID family
Kidscare Home Health of Maryland LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1122 Kenilworth Dr
Ste 501A
Towson, MD 21204
Phone (703) 679-7837

Ownership & related parties

All disclosed owners & managing parties 4

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Michal Roget Individual W-2 Managing EmployeeCoo Dec 31, 2021 100%
TMS-CJ Holdings, LLC Organization, Dallas, TX LLC, Holding company, For-profit 5% Or Greater Direct Ownership Interest Dec 31, 2021 100%
Cortney Baker Individual 5% Or Greater Indirect Ownership InterestCeo Dec 31, 2021 100%
Corporate OfficerCeo Dec 31, 2021 100%
Corporate DirectorCeo Dec 31, 2021 100%
Jason M Baker Individual Corporate OfficerCfo Dec 31, 2021 100%

Facilities with the same owner 7

Facilities that share an organizational owner with 5% or greater ownership or operational control.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1405987200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733788800000",
    "number": "1700293784",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4201 SPRING VALLEY RD STE 600",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752443631",
            "telephone_number": "866-919-3240",
            "fax_number": "877-300-7394"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1122 KENILWORTH DR STE 501A",
            "city": "TOWSON",
            "state": "MD",
            "postal_code": "212042191",
            "telephone_number": "703-679-7837",
            "fax_number": "800-803-8356"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIDSCARE HOME HEALTH OF MARYLAND, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-22",
        "last_updated": "2024-12-10",
        "certification_date": "2024-12-10",
        "status": "A",
        "authorized_official_last_name": "KASKAVAGE",
        "authorized_official_first_name": "KELLY",
        "authorized_official_title_or_position": "DIRECTOR OF COMPLIANCE",
        "authorized_official_telephone_number": "214-575-2999"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "107543861",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Towson, MD

Sources for this page

Verify at the official NPI Registry.