NPIMap

Organization Active NPI

Kidscare Home Health of South Carolina, LLC

  • Home Health Agency
  • North Charleston, SC
National Provider Identifier
1942952932
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 SOUTH CAROLINA, LLC
Practice address
4105 Faber Place Dr Ste 420
North Charleston, SC 29405-8594
Phone
(843) 894-7347
Fax
(843) 278-8599
NPI assigned
Jan 21, 2022
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 Primary

Addresses

Primary practice location

4105 Faber Place Dr Ste 420
North Charleston, SC 29405-8594

Mailing address

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

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220909000682 SC Part A Provider - Home Health Agency 2961887054 Practice locations: North Charleston, SC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1942952932. Details of each certification follow.

Home health agency certification: CCN 427862

Legal name
KIDSCARE HOME HEALTH OF SOUTH CAROLINA, LLC
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Oct 27, 2022
Last certification
Oct 27, 2022
Ownership / control type
Proprietary
Organization structure
LLCProprietary
Incorporated
Mar 5, 2021 in TX
Enrollment address
4105 Faber Place Dr
Ste 420
North Charleston, SC 29405-8594

Care Compare: Home health agency

Medicare Care Compare
Listed as
Kidscare Home Health of South Carolina LLCCCN 427862 · All quality measures
Ownership
Proprietary
Certified
Oct 27, 2022
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Speech pathology

National Provider Directory

National Provider Directory

Locations

4105 Faber Place Dr
Ste 420
North Charleston, SC 29405
Phone (843) 894-7347

Ownership & related parties

All disclosed owners & managing parties 3

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 May 11, 2022 100%
TMS-CJ Holdings, LLC Organization, Dallas, TX LLC 5% Or Greater Direct Ownership Interest May 11, 2022 100%
Cortney Baker Individual 5% Or Greater Indirect Ownership InterestCeo May 11, 2022 100%
Corporate OfficerCeo May 11, 2022 100%
Corporate DirectorCeo May 11, 2022 100%

Facilities with the same owner 7

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

Practitioners & affiliated clinicians

Practitioners 24

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1642723200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733788800000",
    "number": "1942952932",
    "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": "4105 FABER PLACE DR STE 420",
            "city": "NORTH CHARLESTON",
            "state": "SC",
            "postal_code": "294058594",
            "telephone_number": "843-894-7347",
            "fax_number": "843-278-8599"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIDSCARE HOME HEALTH OF SOUTH CAROLINA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-21",
        "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": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in North Charleston, SC

Sources for this page

Verify at the official NPI Registry.