Healthcare Provider Details

I. General information

NPI: 1881252385
Provider Name (Legal Business Name): XTRACOMFORT HOME HEALTH AGENCY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2019
Last Update Date: 05/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6311 EVANSTON AVE STE A
RAYTOWN MO
64133-4929
US

IV. Provider business mailing address

6311 EVANSTON AVE STE A
RAYTOWN MO
64133-4929
US

V. Phone/Fax

Practice location:
  • Phone: 816-328-9304
  • Fax:
Mailing address:
  • Phone: 816-328-9304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ADEREMI MILLER
Title or Position: ADMINISTRATOR
Credential: MBA, BSN, RN
Phone: 816-328-9304