Provider Demographics
NPI:1952727273
Name:XTRACARE ADULT DAY CARE CENTER, LLC.
Entity Type:Organization
Organization Name:XTRACARE ADULT DAY CARE CENTER, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:A
Authorized Official - Last Name:IYEWARUN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD - IOWA STATE U
Authorized Official - Phone:816-272-2533
Mailing Address - Street 1:6311 EVANSTON AVE
Mailing Address - Street 2:
Mailing Address - City:RAYTOWN
Mailing Address - State:MO
Mailing Address - Zip Code:64133-4929
Mailing Address - Country:US
Mailing Address - Phone:816-272-2533
Mailing Address - Fax:816-298-1426
Practice Address - Street 1:6311 EVANSTON AVE
Practice Address - Street 2:
Practice Address - City:RAYTOWN
Practice Address - State:MO
Practice Address - Zip Code:64133-4929
Practice Address - Country:US
Practice Address - Phone:816-272-2533
Practice Address - Fax:816-298-1426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-11
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care