Healthcare Provider Details

I. General information

NPI: 1205651437
Provider Name (Legal Business Name): GRAFFITI CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2024
Last Update Date: 11/21/2024
Certification Date: 11/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 ELMWOOD AVE
KANSAS CITY MO
64124-2920
US

IV. Provider business mailing address

3630 BEECH HILL DR
SPRING TX
77388-5706
US

V. Phone/Fax

Practice location:
  • Phone: 228-265-0331
  • Fax:
Mailing address:
  • Phone: 228-265-0331
  • 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 Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: TYTEILA M ROACH
Title or Position: OWNER
Credential:
Phone: 228-265-0331