Healthcare Provider Details

I. General information

NPI: 1205388998
Provider Name (Legal Business Name): BETHEL HOME HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2016
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 MAIN ST STE 900
KANSAS CITY MO
64108-2408
US

IV. Provider business mailing address

2300 MAIN ST STE 900
KANSAS CITY MO
64108-2408
US

V. Phone/Fax

Practice location:
  • Phone: 816-808-5221
  • Fax:
Mailing address:
  • Phone: 816-808-5221
  • Fax: 816-886-7879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. DARLENE MARIE DAVIS
Title or Position: EXECUTIVE OWNER
Credential:
Phone: 816-808-5221