Provider Demographics
NPI:1417020025
Name:KC'S HOME HEALTHCARE, INC.
Entity Type:Organization
Organization Name:KC'S HOME HEALTHCARE, INC.
Other - Org Name:KC'S HOME HEALTHCARE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:L
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-923-2550
Mailing Address - Street 1:6145 TROOST AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64110-3435
Mailing Address - Country:US
Mailing Address - Phone:816-923-2550
Mailing Address - Fax:816-923-7134
Practice Address - Street 1:6145 TROOST AVE
Practice Address - Street 2:STE 200
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64110-3435
Practice Address - Country:US
Practice Address - Phone:816-923-2550
Practice Address - Fax:816-923-7134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO7294251E00000X
KSA105046251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO267574Medicare ID - Type UnspecifiedHOME HEALTHCARE