MEDICARE: NORTHLAND ADULT DAY CENTER 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	261QA0600X	Adult Day Care Clinic/Center		MO

General Provider Information

NPI Number	:	1992151088
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHLAND ADULT DAY CENTER LLC

Provider Business Mailing Address
First Line	:	1613 SWIFT AVE
Second Line	:
City	:	NORTH KANSAS CITY
State	:	MO
Zip	:	64116-3822
Country	:	US
Telephone Number	:	816-844-3955
Fax Number	:

Provider Business Practice Location Address
First Line	:	1613 SWIFT AVE
Second Line	:
City	:	NORTH KANSAS CITY
State	:	MO
Zip	:	64116-3822
Country	:	US
Telephone Number	:	816-305-3660
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	NICKI D BRICE
Credential	:
Telephone Number	:	816-844-3955

Provider Enumeration Date	:	05/09/2016
Last Update Date	:	12/21/2022

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