Provider Demographics
NPI:1801015763
Name:AFTERCAE ASSISTES LIVING. LLC
Entity Type:Organization
Organization Name:AFTERCAE ASSISTES LIVING. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-444-5006
Mailing Address - Street 1:6301 ROCKHILL RD
Mailing Address - Street 2:STE 100
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131-1124
Mailing Address - Country:US
Mailing Address - Phone:816-444-5006
Mailing Address - Fax:816-923-7134
Practice Address - Street 1:6301 ROCKHILL RD
Practice Address - Street 2:STE 100
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64131-1124
Practice Address - Country:US
Practice Address - Phone:816-444-5006
Practice Address - Fax:816-923-7134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO266041409251E00000X
MO286041405251E00000X
KS200370840A251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOM266041409Medicaid
KS200370840AMedicaid
MOM286041405Medicaid