MEDICARE: COMMUNITY SUPPORT PARTNERS

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	6368-9311	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	856252903	OTHER	MO	PROVIDER NUMBER

General Provider Information

NPI Number	:	1376681650
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY SUPPORT PARTNERS

Provider Business Mailing Address
First Line	:	10330 HICKMAN MILLS DR
Second Line	:	BLDG 2
City	:	KANSAS CITY
State	:	MO
Zip	:	64137-1618
Country	:	US
Telephone Number	:	816-777-1301
Fax Number	:	816-777-1305

Provider Business Practice Location Address
First Line	:	8600 E 74TH ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64133-6318
Country	:	US
Telephone Number	:	816-777-1301
Fax Number	:	816-777-1305

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

Provider Enumeration Date	:	02/01/2007
Last Update Date	:	06/09/2009

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Directions to “COMMUNITY SUPPORT PARTNERS ” Practice Location

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