Provider Demographics
NPI:1255686986
Name:ESSENTIA HOME CAE LLC
Entity Type:Organization
Organization Name:ESSENTIA HOME CAE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:JR
Authorized Official - Credentials:RN
Authorized Official - Phone:816-916-8703
Mailing Address - Street 1:7701 NW 74TH TER
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64152-2322
Mailing Address - Country:US
Mailing Address - Phone:816-916-8703
Mailing Address - Fax:
Practice Address - Street 1:7701 NW 74TH TER
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64152-2322
Practice Address - Country:US
Practice Address - Phone:816-916-8703
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-18
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home