MEDICARE: EAGLE HEIGHTS ISL SERVICES

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	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility		MO

General Provider Information

NPI Number	:	1386868297
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAGLE HEIGHTS ISL SERVICES

Provider Business Mailing Address
First Line	:	PO BOX 560
Second Line	:
City	:	BELRON
State	:	MO
Zip	:	64012
Country	:	US
Telephone Number	:	816-765-1185
Fax Number	:	816-765-1185

Provider Business Practice Location Address
First Line	:	8905 CAMBRIDGE AVE
Second Line	:	APT 2202
City	:	KANSAS CITY
State	:	MO
Zip	:	64138
Country	:	US
Telephone Number	:	816-965-0701
Fax Number	:

Authorized Official
Title or Position	:	QMRP
Name	:	MS. SUSAN JUDITH DEMPSEY
Credential	:	CTRS
Telephone Number	:	816-765-1185

Provider Enumeration Date	:	04/12/2007
Last Update Date	:	08/22/2020

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