MEDICARE: PREFERRED FAMILY HEALTHCARE

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	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	CC01430115	MO

General Provider Information

NPI Number	:	1154704187
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREFERRED FAMILY HEALTHCARE

Provider Business Mailing Address
First Line	:	1601 OLD SOUTH RIVER RD
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63303-4120
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7710 E 102ND ST
Second Line	:	ADP
City	:	KANSAS CITY
State	:	MO
Zip	:	64134-2013
Country	:	US
Telephone Number	:	816-767-8090
Fax Number	:

Authorized Official
Title or Position	:	CHIEF REVENUE OFFICER
Name	:	MARK CONOVER
Credential	:
Telephone Number	:	660-665-1962

Provider Enumeration Date	:	07/08/2015
Last Update Date	:	06/10/2022

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Directions to “PREFERRED FAMILY HEALTHCARE ” Practice Location

Language	Start Address	Practice Location

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