MEDICARE: KAH DEVELOPMENT 4, 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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1710337738
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KAH DEVELOPMENT 4, LLC

Provider Business Mailing Address
First Line	:	6330 SPRINT PKWY STE 300
Second Line	:
City	:	OVERLAND PARK
State	:	KS
Zip	:	66211-1157
Country	:	US
Telephone Number	:	913-814-2716
Fax Number	:

Provider Business Practice Location Address
First Line	:	222 W WASHINGTON ST
Second Line	:
City	:	CAMDEN
State	:	AR
Zip	:	71701-3958
Country	:	US
Telephone Number	:	870-498-4357
Fax Number	:	870-837-2524

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	JOHN NICHOLS
Credential	:
Telephone Number	:	870-498-4357

Provider Enumeration Date	:	06/21/2016
Last Update Date	:	11/30/2023

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