MEDICARE: TERRACE HOME HEALTH 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	251G00000X	Community Based Hospice Care Agency

General Provider Information

NPI Number	:	1306489984
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TERRACE HOME HEALTH INDEPENDENCE, LLC

Provider Business Mailing Address
First Line	:	PO BOX 51298
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83405-1298
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4721 S CLIFF AVE STE 211
Second Line	:
City	:	INDEPENDENCE
State	:	MO
Zip	:	64055-6969
Country	:	US
Telephone Number	:	816-441-0000
Fax Number	:

Authorized Official
Title or Position	:	COO
Name	:	RORY JAY WILLIAMS
Credential	:
Telephone Number	:	801-318-6476

Provider Enumeration Date	:	10/25/2019
Last Update Date	:	10/25/2019

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