MEDICARE: KENDALLWOOD HOSPICE COMPANY

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	0418HO	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356339279
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KENDALLWOOD HOSPICE COMPANY

Provider Business Mailing Address
First Line	:	2908 NW VIVION RD
Second Line	:
City	:	RIVERSIDE
State	:	MO
Zip	:	64150-1502
Country	:	US
Telephone Number	:	816-587-1000
Fax Number	:	816-587-3000

Provider Business Practice Location Address
First Line	:	2908 NW VIVION RD
Second Line	:
City	:	RIVERSIDE
State	:	MO
Zip	:	64150-1502
Country	:	US
Telephone Number	:	816-587-1000
Fax Number	:	816-587-3000

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MS. MARY Y. REICHERT
Credential	:
Telephone Number	:	816-587-1000

Provider Enumeration Date	:	10/13/2005
Last Update Date	:	05/13/2010

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Directions to “KENDALLWOOD HOSPICE COMPANY ” Practice Location

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