=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427737840
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JFK COMFORT CARE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/13/2023
-----------------------------------------------------
Last Update Date | 07/13/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 913 SW SARA CIR
-----------------------------------------------------
City | LEES SUMMIT
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64081-3855
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 165-826-4748
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 913 SW SARA CIR
-----------------------------------------------------
City | LEES SUMMIT
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64081-3855
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 165-826-4748
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OPERATIONS MANAGER
-----------------------------------------------------
Name | MR. KENNETH DAWN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 816-582-6474
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 374U00000X
-----------------------------------------------------
Taxonomy Name | Home Health Aide
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------