Provider Demographics
NPI:1316934086
Name:INTERIM HEALTHCARE OF KANSAS CITY, INC
Entity type:Organization
Organization Name:INTERIM HEALTHCARE OF KANSAS CITY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:GREWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-381-3100
Mailing Address - Street 1:10977 GRANADA LN
Mailing Address - Street 2:SUITE 205
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1468
Mailing Address - Country:US
Mailing Address - Phone:913-381-3100
Mailing Address - Fax:
Practice Address - Street 1:10977 GRANADA LN
Practice Address - Street 2:SUITE 205
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211-1468
Practice Address - Country:US
Practice Address - Phone:913-381-3100
Practice Address - Fax:913-381-3181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-28
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO28813251E00000X
KSA046001251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100113890BMedicaid
KS100113890AMedicaid
MO941714206Medicaid
MO267947000Medicaid
MO177087Medicare ID - Type Unspecified
KS100113890AMedicaid