Healthcare Provider Details

I. General information

NPI: 1508010448
Provider Name (Legal Business Name): KAIL ENTERPRISES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2008
Last Update Date: 05/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 NE LAKEWOOD WAY #112
LEES SUMMIT MO
64064-1702
US

IV. Provider business mailing address

4201 NE LAKEWOOD WAY #112
LEES SUMMIT MO
64064-1702
US

V. Phone/Fax

Practice location:
  • Phone: 816-795-7797
  • Fax: 816-795-7796
Mailing address:
  • Phone: 816-795-7797
  • Fax: 816-795-7796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number20258224
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number20258224
License Number StateMO

VIII. Authorized Official

Name: MRS. SHELLEY KATHRYN GORDON
Title or Position: OWNER
Credential:
Phone: 816-795-7797