Healthcare Provider Details

I. General information

NPI: 1093846495
Provider Name (Legal Business Name): MIDLAND EMPIRE RESOURCES FOR INDEPENDENT LIVING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 02/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1506 S RIVERSIDE RD
SAINT JOSEPH MO
64507-2578
US

IV. Provider business mailing address

4420 S 40TH ST
SAINT JOSEPH MO
64503-2157
US

V. Phone/Fax

Practice location:
  • Phone: 816-364-0900
  • Fax: 816-364-3430
Mailing address:
  • Phone: 816-364-0900
  • Fax: 816-364-0588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number867-HH
License Number StateMO

VIII. Authorized Official

Name: JC DOLLAR
Title or Position: CEO
Credential:
Phone: 816-279-8558