# HOME AWAY FROM HOME HEALTHCARE FACILITY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1124233770
- **Authorized official:** MRS. ANGELINA MARIE REYNOLDS (CO-OWNER)
- **Authorized official phone:** (816) 525-2470

## Contact information

- **Practice address:** 13323 CRYSTAL AVE, GRANDVIEW, MO 64030-3338
- **Practice address phone:** (816) 525-2470
- **Mailing address:** 2004 SW KLINE AVE, LEES SUMMIT, MO 64082-4064
- **Mailing address phone:** (816) 525-2470

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 05/14/2007
- **Last updated:** 02/28/2008