=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689356537
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | A RARE KIND OF CARE LC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/01/2023
-----------------------------------------------------
Last Update Date | 08/01/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 230 FORT ZUMWALT SQ
-----------------------------------------------------
City | O FALLON
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63366-3064
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 636-409-4763
-----------------------------------------------------
Fax | 636-294-7371
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 230 FORT ZUMWALT SQ
-----------------------------------------------------
City | O FALLON
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63366-3064
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 636-409-4763
-----------------------------------------------------
Fax | 636-294-7371
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PART OWNER/ DIRECTOR
-----------------------------------------------------
Name | BRITTANY C JACKSON
-----------------------------------------------------
Credential | CNA
-----------------------------------------------------
Telephone | 636-409-4763
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------