MEDICARE: PRAIRIE VIEW HEALTHCARE OF MISSOURI 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	251G00000X	Community Based Hospice Care Agency

General Provider Information

NPI Number	:	1154025013
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRAIRIE VIEW HEALTHCARE OF MISSOURI INC

Provider Business Mailing Address
First Line	:	4551 PENNSYLVANIA AVE UNIT 1321
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64111-3456
Country	:	US
Telephone Number	:	913-515-8203
Fax Number	:	913-273-1080

Provider Business Practice Location Address
First Line	:	1301 OAK ST STE 514
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64106-2804
Country	:	US
Telephone Number	:	913-515-8203
Fax Number	:	913-273-1080

Authorized Official
Title or Position	:	CEO/OWNER
Name	:	JEREMY SAPORITO
Credential	:
Telephone Number	:	913-515-8203

Provider Enumeration Date	:	03/27/2023
Last Update Date	:	05/08/2023

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