1437397833 NPI number — COMMUNITY SUPPORT PARTNERS

Table of content: (NPI 1437397833)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437397833 NPI number — COMMUNITY SUPPORT PARTNERS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMUNITY SUPPORT PARTNERS
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:
Provider Other Organization Name Type Code:
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:
1437397833
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/23/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10330 HICKMAN MILLS DR
Provider Second Line Business Mailing Address:
BUILDING 2
Provider Business Mailing Address City Name:
KANSAS CITY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64137-1618
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11818 E 60TH TER
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64133-4336
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-777-1301
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/23/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ROYER
Authorized Official First Name:
CORY
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
816-777-1301

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: 856252903 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 856272703 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 856285408 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".