Healthcare Provider Details

I. General information

NPI: 1972857688
Provider Name (Legal Business Name): CARLA MARIE AVERY-HUTCHINS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2012
Last Update Date: 12/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12420 W 119TH TER APT 714
OVERLAND PARK KS
66213-5727
US

IV. Provider business mailing address

10606 E 34TH ST S
INDEPENDENCE MO
64052-2624
US

V. Phone/Fax

Practice location:
  • Phone: 913-766-3400
  • Fax:
Mailing address:
  • Phone: 816-392-9878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number StateKS

VIII. Authorized Official

Name: MS. CARLA MARIE AVERY-HUTCHINS
Title or Position: DIRECTOR/OWNER
Credential:
Phone: 816-392-9878