Healthcare Provider Details

I. General information

NPI: 1912829433
Provider Name (Legal Business Name): CEDAR FAMILY CARE MISSOURI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 S LEXINGTON ST STE 100
HARRISONVILLE MO
64701-2443
US

IV. Provider business mailing address

117 S LEXINGTON ST STE 100
HARRISONVILLE MO
64701-2443
US

V. Phone/Fax

Practice location:
  • Phone: 314-266-8625
  • Fax:
Mailing address:
  • Phone: 314-266-8625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. NIKITA CHACKO
Title or Position: OPERATIONAL MANAGER
Credential:
Phone: 314-266-8625