Provider Demographics
NPI:1467085811
Name:AT HOME INDEPENDENCE QUALITY HOME CARE,LLC
Entity Type:Organization
Organization Name:AT HOME INDEPENDENCE QUALITY HOME CARE,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:S
Authorized Official - Last Name:DELGADO
Authorized Official - Suffix:
Authorized Official - Credentials:PSY D, LPC
Authorized Official - Phone:417-448-8960
Mailing Address - Street 1:216 W CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:NEVADA
Mailing Address - State:MO
Mailing Address - Zip Code:64772-3362
Mailing Address - Country:US
Mailing Address - Phone:417-448-8960
Mailing Address - Fax:417-448-6555
Practice Address - Street 1:216 W CHERRY ST
Practice Address - Street 2:
Practice Address - City:NEVADA
Practice Address - State:MO
Practice Address - Zip Code:64772-3362
Practice Address - Country:US
Practice Address - Phone:417-448-8960
Practice Address - Fax:417-448-6555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-13
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO267126100Medicaid
MO280088995Medicaid
MO495908006Medicaid
MO260088991Medicaid