MEDICARE: AT HOME INDEPENDENCE,LLC

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	253Z00000X	In Home Supportive Care Agency
2	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1134414303
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AT HOME INDEPENDENCE,LLC

Provider Business Mailing Address
First Line	:	216 W CHERRY ST
Second Line	:
City	:	NEVADA
State	:	MO
Zip	:	64772-3362
Country	:	US
Telephone Number	:	417-448-8960
Fax Number	:	417-448-6555

Provider Business Practice Location Address
First Line	:	216 W CHERRY ST
Second Line	:
City	:	NEVADA
State	:	MO
Zip	:	64772-3362
Country	:	US
Telephone Number	:	417-448-8960
Fax Number	:	417-448-6555

Authorized Official
Title or Position	:	CEO & EXECUTIVE DIRECTOR
Name	:	KIMBERLY SUE DELGADO
Credential	:	PSY D, LPC
Telephone Number	:	417-448-8960

Provider Enumeration Date	:	06/15/2011
Last Update Date	:	04/04/2024

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Directions to “AT HOME INDEPENDENCE,LLC ” Practice Location

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