Healthcare Provider Details

I. General information

NPI: 1760283048
Provider Name (Legal Business Name): NEW CREATION HOME HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2025
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1670 E 355TH RD
BOLIVAR MO
65613-8334
US

IV. Provider business mailing address

1670 E 355TH RD
BOLIVAR MO
65613-8334
US

V. Phone/Fax

Practice location:
  • Phone: 816-590-6757
  • Fax:
Mailing address:
  • Phone: 816-590-6757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: TODD SOMMER
Title or Position: CEO
Credential:
Phone: 816-590-6757