MEDICARE: ADAMS ACTIVELY AGING INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
11	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053450825
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADAMS ACTIVELY AGING INC.

Provider Business Mailing Address
First Line	:	3145 SYLVANIE ST
Second Line	:
City	:	SAINT JOSEPH
State	:	MO
Zip	:	64501-3322
Country	:	US
Telephone Number	:	816-671-0031
Fax Number	:

Provider Business Practice Location Address
First Line	:	3145 SYLVANIE ST
Second Line	:
City	:	SAINT JOSEPH
State	:	MO
Zip	:	64501-3322
Country	:	US
Telephone Number	:	816-671-0032
Fax Number	:

Authorized Official
Title or Position	:	VP MANAGER
Name	:	MR. CHARLES DAVID ADAMS
Credential	:
Telephone Number	:	816-671-0031

Provider Enumeration Date	:	02/06/2007
Last Update Date	:	02/11/2009

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