Provider Demographics
NPI:1669234860
Name:COMMON GROUNDS HOME HEALTH SERVICES
Entity type:Organization
Organization Name:COMMON GROUNDS HOME HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAMIKA
Authorized Official - Middle Name:MONEA
Authorized Official - Last Name:HANKS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:816-277-2113
Mailing Address - Street 1:9700 E 84TH ST
Mailing Address - Street 2:
Mailing Address - City:RAYTOWN
Mailing Address - State:MO
Mailing Address - Zip Code:64138-3395
Mailing Address - Country:US
Mailing Address - Phone:816-277-2113
Mailing Address - Fax:
Practice Address - Street 1:818 1/2 E 31ST ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64109-1441
Practice Address - Country:US
Practice Address - Phone:816-277-2113
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-24
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health