MEDICARE: BEAUTIFUL BLESSINGS

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	22059525	OTHER	MO	DMH GROUP HOME

General Provider Information

NPI Number	:	1588842652
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEAUTIFUL BLESSINGS

Provider Business Mailing Address
First Line	:	9525 N KENWOOD CT
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64155-3337
Country	:	US
Telephone Number	:	816-734-4377
Fax Number	:

Provider Business Practice Location Address
First Line	:	9525 N KENWOOD CT
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64155-3337
Country	:	US
Telephone Number	:	816-734-4377
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. PHYLLIS ANN DOWNTON
Credential	:	CNA,CMT, CMA,
Telephone Number	:	816-728-2568

Provider Enumeration Date	:	01/31/2008
Last Update Date	:	01/31/2008

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Directions to “BEAUTIFUL BLESSINGS ” Practice Location

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