Healthcare Provider Details

I. General information

NPI: 1134414303
Provider Name (Legal Business Name): AT HOME INDEPENDENCE,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2011
Last Update Date: 04/04/2024
Certification Date: 04/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 W CHERRY ST
NEVADA MO
64772-3362
US

IV. Provider business mailing address

216 W CHERRY ST
NEVADA MO
64772-3362
US

V. Phone/Fax

Practice location:
  • Phone: 417-448-8960
  • Fax: 417-448-6555
Mailing address:
  • Phone: 417-448-8960
  • Fax: 417-448-6555

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

VIII. Authorized Official

Name: KIMBERLY SUE DELGADO
Title or Position: CEO & EXECUTIVE DIRECTOR
Credential: PSY D, LPC
Phone: 417-448-8960