Healthcare Provider Details

I. General information

NPI: 1538113824
Provider Name (Legal Business Name): IN HOME HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 01/05/2023
Certification Date: 01/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4731 S COCHISE DR STE 120
INDEPENDENCE MO
64055-6975
US

IV. Provider business mailing address

333 N SUMMIT ST ATTN DEAN SHIPMAN
TOLEDO OH
43604-1531
US

V. Phone/Fax

Practice location:
  • Phone: 816-943-1798
  • Fax: 816-941-3881
Mailing address:
  • Phone: 419-254-7841
  • Fax: 419-252-6448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number713-6
License Number StateMO

VIII. Authorized Official

Name: MARTIN DAVID ALLEN
Title or Position: DIRECTOR
Credential:
Phone: 419-252-5734