Provider Demographics
NPI:1215428735
Name:AT HOME INDEPENDENCE IN HOME CARE
Entity type:Organization
Organization Name:AT HOME INDEPENDENCE IN HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:DELGADO
Authorized Official - Suffix:
Authorized Official - Credentials:PSY D, LPC
Authorized Official - Phone:417-448-8960
Mailing Address - Street 1:216 W CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:NEVADA
Mailing Address - State:MO
Mailing Address - Zip Code:64772-3362
Mailing Address - Country:US
Mailing Address - Phone:417-448-8960
Mailing Address - Fax:417-448-6555
Practice Address - Street 1:216 W CHERRY ST
Practice Address - Street 2:
Practice Address - City:NEVADA
Practice Address - State:MO
Practice Address - Zip Code:64772-3362
Practice Address - Country:US
Practice Address - Phone:417-448-8960
Practice Address - Fax:417-448-6555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-21
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No385H00000XRespite Care FacilityRespite Care