Healthcare Provider Details

I. General information

NPI: 1215428735
Provider Name (Legal Business Name): AT HOME INDEPENDENCE IN HOME CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2018
Last Update Date: 11/17/2020
Certification Date: 11/17/2020
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 Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

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