Organization
XTRACOMFORT HOME HEALTH AGENCY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ADEREMI MILLER MBA, BSN, RN (ADMINISTRATOR)
(816) 328-9304
Entity
Organization
Contact information
Practice address
6311 EVANSTON AVE STE A, RAYTOWN, MO 64133-4929
(816) 328-9304
Mailing address
6311 EVANSTON AVE STE A, RAYTOWN, MO 64133-4929
(816) 328-9304
Taxonomy
Speciality
Code
Description
License number
State
163WH0200X
Home Health Registered Nurse
—
—
251E00000X
Home Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1700253150
—
MO
05
—
1952727273
—
MO
Enumeration date
05/31/2019
Last updated
05/31/2019
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