Provider Demographics
NPI:1952600256
Name:NUTRICARE HUMAN SERVICES INC.
Entity Type:Organization
Organization Name:NUTRICARE HUMAN SERVICES INC.
Other - Org Name:NUTRICARE IN-HOME SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DESIGNATED MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MIKAL
Authorized Official - Middle Name:RABWAH
Authorized Official - Last Name:NAGAMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-349-8635
Mailing Address - Street 1:414 REMINGTON PLAZA CT
Mailing Address - Street 2:
Mailing Address - City:RAYMORE
Mailing Address - State:MO
Mailing Address - Zip Code:64083-8599
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:414 REMINGTON PLAZA CT
Practice Address - Street 2:
Practice Address - City:RAYMORE
Practice Address - State:MO
Practice Address - Zip Code:64083-8599
Practice Address - Country:US
Practice Address - Phone:816-349-8635
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-25
Last Update Date:2011-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care