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General NPI Number Information
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NPI Number | 1801635396
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Entity Type | Organization
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Legal Business Name | CLASSIC CARE IN-HOME HEALTH SERVICE
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Dates
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Enumeration Date | 05/23/2024
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Last Update Date | 05/23/2024
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Provider Practice Location Address
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Address Line | 8725 COUNTRYSHIRE LN APT 4
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City | KANSAS CITY
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State | MO
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Zip | 64138-1264
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Country | US
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Telephone | 816-651-7409
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Fax |
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Provider Business Mailing Address
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Address Line | 8725 COUNTRYSHIRE LN
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City | KANSAS CITY
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State | MO
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Zip | 64138-1290
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | TIAUNNA SHAWNTWONE' JILES
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Credential |
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Telephone | 816-651-7409
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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