Organization · NPI-2
417 Home Care LLC
In Home Supportive Care · Ozark, MO
NPI number1164971933
StatusActive
Last updated in NPPESMar 7, 2023
Details
- NPI
- 1164971933
- Entity type
- Organization (NPI-2)
- Legal business name
- 417 Home Care LLC
- Organization subpart
- No
- Enumeration date
- Sep 22, 2016
- Certification date
- Mar 7, 2023
- Last updated
- Mar 7, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 253Z00000X | In Home Supportive Care | – | – | Yes |
| 372500000X | Chore Provider | – | – | |
| 372600000X | Adult Companion | – | – | |
| 3747A0650X | Technician, Attendant Care Provider | – | – | |
| 3747P1801X | Technician, Personal Care Attendant | – | – | |
| 374U00000X | Home Health Aide | – | – | |
| 376J00000X | Homemaker | – | – | |
| 376K00000X | Nurse's Aide | – | – |
Other names
- Haven Home Care (Doing Business As)
Practice location
850 N 25th StOzark, MO 65721-8033
Phone 417-581-1234 · Fax 888-844-7031
Mailing address
850 N 25th StOzark, MO 65721-8033
Phone 417-581-1234 · Fax 888-844-7031
Authorized official
John Ross Ray
Ceo
4174965958
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.