Provider Demographics
NPI:1932823648
Name:MATHIS, MONICA R (OPENING ADULT DAY)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:R
Last Name:MATHIS
Suffix:
Gender:F
Credentials:OPENING ADULT DAY
Other - Prefix:
Other - First Name:MONICA
Other - Middle Name:R
Other - Last Name:MATHIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9601 E TRUMAN RD
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64052-2165
Mailing Address - Country:US
Mailing Address - Phone:816-749-9460
Mailing Address - Fax:
Practice Address - Street 1:9601 E TRUMAN RD
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64052-2165
Practice Address - Country:US
Practice Address - Phone:816-749-9460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-27
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO00000000385HR2050X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2050XRespite Care FacilityRespite CareRespite Care Camp