MEDICARE: KAM QUALITY HOME CARE, 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	302R00000X	Health Maintenance Organization	302R00000X	MO

General Provider Information

NPI Number	:	1184055022
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KAM QUALITY HOME CARE, LLC

Provider Business Mailing Address
First Line	:	5110 MIDDAY DR
Second Line	:
City	:	BLACK JACK
State	:	MO
Zip	:	63033-8521
Country	:	US
Telephone Number	:	314-741-9981
Fax Number	:	314-741-9982

Provider Business Practice Location Address
First Line	:	5110 MIDDAY DR
Second Line	:
City	:	BLACK JACK
State	:	MO
Zip	:	63033-8521
Country	:	US
Telephone Number	:	314-741-9981
Fax Number	:	314-741-9982

Authorized Official
Title or Position	:	CEO/OWNER
Name	:	MRS. MARILYN DENISE HUBBARD
Credential	:
Telephone Number	:	314-741-9981

Provider Enumeration Date	:	12/03/2013
Last Update Date	:	12/03/2013

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