Provider Demographics
NPI:1629365754
Name:HOMECARE PROVIDERS GROUP LLC
Entity Type:Organization
Organization Name:HOMECARE PROVIDERS GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:KAIL
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:417-234-3868
Mailing Address - Street 1:5452 S PINEHURST AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65810-2768
Mailing Address - Country:US
Mailing Address - Phone:417-234-3868
Mailing Address - Fax:888-511-3547
Practice Address - Street 1:5452 S PINEHURST AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65810-2768
Practice Address - Country:US
Practice Address - Phone:417-234-3868
Practice Address - Fax:888-511-3547
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-10
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000164718363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOMA3550OtherMEDICARE PTAN