MEDICARE: DAVIS HEALTH CARE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3104A0630X	Assisted Living Facility (Behavioral Disturbances)	035138	MO

General Provider Information

NPI Number	:	1134397524
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVIS HEALTH CARE, INC.

Provider Business Mailing Address
First Line	:	2905 CAMPBELL ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64109-1417
Country	:	US
Telephone Number	:	816-531-6168
Fax Number	:	806-931-7380

Provider Business Practice Location Address
First Line	:	2905 CAMPBELL ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64109-1417
Country	:	US
Telephone Number	:	816-531-6168
Fax Number	:	816-931-7380

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. DANNY LEE DAVIS
Credential	:	PRESIDENT
Telephone Number	:	816-753-4992

Provider Enumeration Date	:	02/19/2008
Last Update Date	:	02/19/2008

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