Healthcare Provider Details

I. General information

NPI: 1639030109
Provider Name (Legal Business Name): LATREACE ANTHONY CNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHERRY TREE CNA

II. Dates (important events)

Enumeration Date: 11/24/2025
Last Update Date: 11/24/2025
Certification Date: 10/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1104 ASKEW AVE
KANSAS CITY MO
64127-1521
US

IV. Provider business mailing address

1104 ASKEW AVE
KANSAS CITY MO
64127-1521
US

V. Phone/Fax

Practice location:
  • Phone: 816-335-7030
  • Fax:
Mailing address:
  • Phone: 816-335-7030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License NumberMO026850901879
License Number State
# 2
Primary TaxonomyN
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License NumberMO026850901879
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License NumberMO026850901879
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code374T00000X
TaxonomyReligious Nonmedical Nursing Personnel
License NumberMO026850901879
License Number StateMO
# 5
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License NumberMO026850901879
License Number StateMO
# 6
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberMO026850901879
License Number StateMO
# 7
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberMO026850901879
License Number StateMO
# 8
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberMO026850901879
License Number StateMO
# 9
Primary TaxonomyN
Taxonomy Code146D00000X
TaxonomyPersonal Emergency Response Attendant
License NumberMO026850901879
License Number StateMO
# 10
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberMO026850901879
License Number StateMO
# 11
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License NumberMO026850901879
License Number StateMO
# 12
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License NumberMO026850901879
License Number StateMO
# 13
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License NumberMO026850901879
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: