Healthcare Provider Details

I. General information

NPI: 1285119545
Provider Name (Legal Business Name): INITY CCPRX HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2018
Last Update Date: 09/26/2023
Certification Date: 09/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8930 EVANSTON AVE
KANSAS CITY MO
64138-4732
US

IV. Provider business mailing address

8930 EVANSTON AVE
KANSAS CITY MO
64138-4732
US

V. Phone/Fax

Practice location:
  • Phone: 816-617-1398
  • Fax: 816-832-8236
Mailing address:
  • Phone: 816-617-1398
  • Fax: 816-832-8236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: FRANCES (NIA) EVELYN BECKER
Title or Position: OWNER/ADMINISTRATOR
Credential: R.N.B.S.N.C.M.O.E.
Phone: 816-617-1398