MEDICARE: KC HOME CARE 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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1710502141
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KC HOME CARE LLC

Provider Business Mailing Address
First Line	:	5515 SAINT JOHN AVE
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64123-1815
Country	:	US
Telephone Number	:	816-888-4635
Fax Number	:	866-240-2199

Provider Business Practice Location Address
First Line	:	5515 SAINT JOHN AVE
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64123-1815
Country	:	US
Telephone Number	:	816-888-4635
Fax Number	:	866-240-2199

Authorized Official
Title or Position	:	OWNER
Name	:	BASHIR OSMAN AHMED
Credential	:
Telephone Number	:	816-888-4635

Provider Enumeration Date	:	06/11/2020
Last Update Date	:	08/08/2024

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