=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467085811
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AT HOME INDEPENDENCE QUALITY HOME CARE,LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/13/2020
-----------------------------------------------------
Last Update Date | 12/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 216 W CHERRY ST
-----------------------------------------------------
City | NEVADA
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64772-3362
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 417-448-8960
-----------------------------------------------------
Fax | 417-448-6555
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 216 W CHERRY ST
-----------------------------------------------------
City | NEVADA
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64772-3362
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 417-448-8960
-----------------------------------------------------
Fax | 417-448-6555
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO/EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | KIMBERLY S DELGADO
-----------------------------------------------------
Credential | PSY D, LPC
-----------------------------------------------------
Telephone | 417-448-8960
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------