Provider Demographics
NPI:1427478213
Name:CORE HOME HEALTH AGENCY LLC
Entity type:Organization
Organization Name:CORE HOME HEALTH AGENCY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:BO
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-795-7990
Mailing Address - Street 1:2311 S REDWOOD AVE STE A
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64057-2405
Mailing Address - Country:US
Mailing Address - Phone:816-795-7990
Mailing Address - Fax:
Practice Address - Street 1:2311 S REDWOOD AVE STE A
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64057-2405
Practice Address - Country:US
Practice Address - Phone:816-795-7990
Practice Address - Fax:816-795-7990
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CORE HOME HEALTH AGENCY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-04-21
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO267653Medicare UPIN
MO267653Medicare PIN