1366640914 NPI number — CENTER FOR THE DEVELOPMENTALLY DISABLED

Table of content: (NPI 1366640914)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366640914 NPI number — CENTER FOR THE DEVELOPMENTALLY DISABLED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTER FOR THE DEVELOPMENTALLY DISABLED
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SPECIAL NEIGHBORS
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366640914
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/07/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1010 W. 39TH STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KANSAS CITY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64111-3880
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-531-0045
Provider Business Mailing Address Fax Number:
816-756-5612

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1215 W. TRUMAN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INDEPENDENCE
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64050
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-836-3462
Provider Business Practice Location Address Fax Number:
816-836-5158
Provider Enumeration Date:
07/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MUDD
Authorized Official First Name:
SARAH
Authorized Official Middle Name:
H
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
816-531-0045

Provider Taxonomy Codes

  • Taxonomy code: 320900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 853351203 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com