MEDICARE: KINNEY GROUP CARE HOME

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	7171986	MO

General Provider Information

NPI Number	:	1861528986
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KINNEY GROUP CARE HOME

Provider Business Mailing Address
First Line	:	3416 MICHIGAN AVE
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64109-2541
Country	:	US
Telephone Number	:	816-923-9621
Fax Number	:

Provider Business Practice Location Address
First Line	:	3416 MICHIGAN AVE
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64109-2541
Country	:	US
Telephone Number	:	816-923-9621
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	LYNTHIA V. PONDER
Credential	:	R.N.
Telephone Number	:	816-923-9621

Provider Enumeration Date	:	02/25/2007
Last Update Date	:	08/29/2008

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