Healthcare Provider Details

I. General information

NPI: 1851728695
Provider Name (Legal Business Name): KC ADULT RECREATION CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2013
Last Update Date: 10/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1109 N 5TH ST
KANSAS CITY KS
66101-2305
US

IV. Provider business mailing address

1109 N 5TH ST
KANSAS CITY KS
66101-2305
US

V. Phone/Fax

Practice location:
  • Phone: 913-602-1766
  • Fax:
Mailing address:
  • Phone: 913-602-1766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateKS

VIII. Authorized Official

Name: ALICIA MCCOY
Title or Position: PRESIDENT
Credential:
Phone: 913-602-1766