Provider Demographics
NPI:1528594082
Name:PROACTIVE HOME CARE MISSOURI, INC.
Entity Type:Organization
Organization Name:PROACTIVE HOME CARE MISSOURI, INC.
Other - Org Name:PLANNED WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER AND CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-549-7756
Mailing Address - Street 1:336 GRANT ST
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:MO
Mailing Address - Zip Code:64836-1632
Mailing Address - Country:US
Mailing Address - Phone:206-549-7756
Mailing Address - Fax:877-671-3066
Practice Address - Street 1:336 GRANT ST
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:MO
Practice Address - Zip Code:64836-1632
Practice Address - Country:US
Practice Address - Phone:206-549-7756
Practice Address - Fax:877-671-3066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-03
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care