MEDICARE: SACRED HEART HOME CARE

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	A105169	KS

General Provider Information

NPI Number	:	1275836678
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SACRED HEART HOME CARE

Provider Business Mailing Address
First Line	:	7735 WASHINGTON AVE
Second Line	:	SUITE D
City	:	KANSAS CITY
State	:	KS
Zip	:	66112-2444
Country	:	US
Telephone Number	:	913-334-1058
Fax Number	:	913-334-1196

Provider Business Practice Location Address
First Line	:	7735 WASHINGTON AVE
Second Line	:	SUITE D
City	:	KANSAS CITY
State	:	KS
Zip	:	66112-2444
Country	:	US
Telephone Number	:	913-334-1058
Fax Number	:	913-334-1196

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BOB BLEVINS
Credential	:
Telephone Number	:	913-334-1058

Provider Enumeration Date	:	12/07/2010
Last Update Date	:	12/07/2010

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Directions to “SACRED HEART HOME CARE ” Practice Location

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