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	:	1770933798
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	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	409 W 4TH ST
Second Line	:
City	:	BRINKLEY
State	:	AR
Zip	:	72021-2113
Country	:	US
Telephone Number	:	870-527-2186
Fax Number	:	870-734-1163

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	JOHN NICHOLS
Credential	:
Telephone Number	:	870-527-2186

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

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