Healthcare Provider Details

I. General information

NPI: 1225517329
Provider Name (Legal Business Name): MISSION PROJECT - PERSON CARE ASSISTANTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2018
Last Update Date: 08/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5960 DEARBORN ST # 225
MISSION KS
66202-3342
US

IV. Provider business mailing address

5960 DEARBORN ST # 225
MISSION KS
66202-3342
US

V. Phone/Fax

Practice location:
  • Phone: 913-777-6722
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MICHAEL LEON BELANCIO
Title or Position: INTERIM MANAGER
Credential: J.D.
Phone: 816-516-4644