Provider Demographics
NPI:1285119545
Name:INITY CCPRX HOME CARE LLC
Entity type:Organization
Organization Name:INITY CCPRX HOME CARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:FRANCES (NIA)
Authorized Official - Middle Name:EVELYN
Authorized Official - Last Name:BECKER
Authorized Official - Suffix:
Authorized Official - Credentials:RNBSNCMOE
Authorized Official - Phone:816-617-1398
Mailing Address - Street 1:8930 EVANSTON AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64138-4732
Mailing Address - Country:US
Mailing Address - Phone:816-617-1398
Mailing Address - Fax:816-832-8236
Practice Address - Street 1:8930 EVANSTON AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64138-4732
Practice Address - Country:US
Practice Address - Phone:816-617-1398
Practice Address - Fax:816-832-8236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-02
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty
No163WC0400XNursing Service ProvidersRegistered NurseCase ManagementGroup - Multi-Specialty