Healthcare Provider Details

I. General information

NPI: 1952727273
Provider Name (Legal Business Name): XTRACARE ADULT DAY CARE CENTER, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2014
Last Update Date: 08/04/2023
Certification Date: 08/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6311 EVANSTON AVE
RAYTOWN MO
64133-4929
US

IV. Provider business mailing address

6311 EVANSTON AVE
RAYTOWN MO
64133-4929
US

V. Phone/Fax

Practice location:
  • Phone: 816-272-2533
  • Fax: 816-298-1426
Mailing address:
  • Phone: 816-272-2533
  • Fax: 816-298-1426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ROSE A. IYEWARUN
Title or Position: DIRECTOR/MANAGER
Credential: PH.D. - IOWA STATE U
Phone: 816-272-2533