MEDICARE: JACOBS WELL OF KANSAS CITY MINISTRIES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility		MO

General Provider Information

NPI Number	:	1083732846
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JACOBS WELL OF KANSAS CITY MINISTRIES

Provider Business Mailing Address
First Line	:	5921 E 31ST ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64129-1163
Country	:	US
Telephone Number	:	816-737-2557
Fax Number	:	816-737-2552

Provider Business Practice Location Address
First Line	:	5921 E 31ST ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64129-1163
Country	:	US
Telephone Number	:	816-737-2557
Fax Number	:	816-737-2552

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MS. KAREN RENEE ALLEN
Credential	:	NCC LPC
Telephone Number	:	816-737-2557

Provider Enumeration Date	:	03/27/2007
Last Update Date	:	08/22/2020

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