MEDICARE: TERRIE WE CARE SERVICES 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	251E00000X	Home Health Agency	LC001536787	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	LC001536787	OTHER	MO	STATE ID

General Provider Information

NPI Number	:	1366929101
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TERRIE WE CARE SERVICES LLC

Provider Business Mailing Address
First Line	:	504 W 101ST TER
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64114-4235
Country	:	US
Telephone Number	:	913-475-3091
Fax Number	:

Provider Business Practice Location Address
First Line	:	1921 E 12TH ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64127-1139
Country	:	US
Telephone Number	:	913-475-3091
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE ADMINISTRATOR
Name	:	MS. YOLANDA R RAY
Credential	:
Telephone Number	:	816-572-6085

Provider Enumeration Date	:	07/24/2018
Last Update Date	:	07/24/2018

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