MEDICARE: ADULT DAYCARING VILLAS, LLC.

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	261QA0600X	Adult Day Care Clinic/Center	765	MO

General Provider Information

NPI Number	:	1215186051
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADULT DAYCARING VILLAS, LLC.

Provider Business Mailing Address
First Line	:	11515 HICKMAN MILLS DR
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64134-4210
Country	:	US
Telephone Number	:	816-765-2273
Fax Number	:	816-765-2277

Provider Business Practice Location Address
First Line	:	11515 HICKMAN MILLS DR
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64134-4210
Country	:	US
Telephone Number	:	816-765-2273
Fax Number	:	816-765-2277

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR/CEO
Name	:	MS. JUNE EVELYN PORTER-LAMOTHE
Credential	:
Telephone Number	:	816-765-2273

Provider Enumeration Date	:	09/17/2008
Last Update Date	:	09/17/2008

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