Provider Demographics
NPI:1679910376
Name:INTERIM HEALTHCARE OF KANSAS CITY, INC.
Entity Type:Organization
Organization Name:INTERIM HEALTHCARE OF KANSAS CITY, INC.
Other - Org Name:INTERIM HEALTHCARE OF KANSAS CITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:GREWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-381-3100
Mailing Address - Street 1:10977 GRANADA LN
Mailing Address - Street 2:SUITE 205
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1468
Mailing Address - Country:US
Mailing Address - Phone:913-381-3100
Mailing Address - Fax:913-642-5683
Practice Address - Street 1:4444 N BELLEVIEW AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-1507
Practice Address - Country:US
Practice Address - Phone:816-420-0533
Practice Address - Fax:816-420-0494
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INTERIM HEALTHCARE OF KANSAS CITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-06-04
Last Update Date:2017-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO26-1653OtherCCN