Provider Demographics
NPI:1902478936
Name:CLAYBORN HOME CARE OF AMERICA, LLC
Entity Type:Organization
Organization Name:CLAYBORN HOME CARE OF AMERICA, LLC
Other - Org Name:VISITING ANGELS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CLAYBORN
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:816-768-0268
Mailing Address - Street 1:5600 NE ANTIOCH RD STE 101
Mailing Address - Street 2:
Mailing Address - City:GLADSTONE
Mailing Address - State:MO
Mailing Address - Zip Code:64119-2303
Mailing Address - Country:US
Mailing Address - Phone:816-768-0268
Mailing Address - Fax:816-319-1518
Practice Address - Street 1:5600 NE ANTIOCH RD STE 101
Practice Address - Street 2:
Practice Address - City:GLADSTONE
Practice Address - State:MO
Practice Address - Zip Code:64119-2303
Practice Address - Country:US
Practice Address - Phone:816-768-0268
Practice Address - Fax:816-319-1518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-09
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care