Provider Demographics
NPI:1104596600
Name:TARA CARES LLC
Entity type:Organization
Organization Name:TARA CARES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:
Authorized Official - Last Name:GAYNOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-342-9458
Mailing Address - Street 1:PO BOX 132
Mailing Address - Street 2:
Mailing Address - City:KIT CARSON
Mailing Address - State:CO
Mailing Address - Zip Code:80825-0132
Mailing Address - Country:US
Mailing Address - Phone:719-962-3203
Mailing Address - Fax:
Practice Address - Street 1:406 DEPEE ST
Practice Address - Street 2:
Practice Address - City:KIT CARSON
Practice Address - State:CO
Practice Address - Zip Code:80825-5029
Practice Address - Country:US
Practice Address - Phone:719-962-3203
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-15
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO25409247Medicaid