Provider Demographics
NPI:1902258387
Name:KC CONSTRUCTION, INC
Entity Type:Organization
Organization Name:KC CONSTRUCTION, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:K
Authorized Official - Last Name:COMBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-807-1019
Mailing Address - Street 1:4319 CHATEAU RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80108-8424
Mailing Address - Country:US
Mailing Address - Phone:303-807-1019
Mailing Address - Fax:303-683-1527
Practice Address - Street 1:4319 CHATEAU RIDGE RD
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80108-8424
Practice Address - Country:US
Practice Address - Phone:303-807-1019
Practice Address - Fax:303-683-1527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-08
Last Update Date:2016-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO241265171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171WH0202XOther Service ProvidersContractorHome ModificationsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO95320032Medicaid