Provider Demographics
NPI:1053450825
Name:ADAMS ACTIVELY AGING INC.
Entity Type:Organization
Organization Name:ADAMS ACTIVELY AGING INC.
Other - Org Name:ACTIVELY AGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-671-0031
Mailing Address - Street 1:3145 SYLVANIE ST
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64501-3322
Mailing Address - Country:US
Mailing Address - Phone:816-671-0031
Mailing Address - Fax:
Practice Address - Street 1:3145 SYLVANIE ST
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64501-3322
Practice Address - Country:US
Practice Address - Phone:816-671-0032
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO251E00000XMedicaid
MO3747P1801XMedicaid
MO376JOOOOOXMedicaid
MO261QPO9O4XMedicaid
MO347C00000XMedicaid
MO376KOOOOOXMedicaid
MO374UOOOOOXMedicaid
MO251C00000XMedicaid
MO311ZAO62OXMedicaid
MO372500000XMedicaid
MO372600000XMedicaid