Healthcare Provider Details

I. General information

NPI: 1154776219
Provider Name (Legal Business Name): COMMUNITY LIVING OPPORTUNITIES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2016
Last Update Date: 03/18/2021
Certification Date: 03/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7725 W 87TH ST
OVERLAND PARK KS
66212-1905
US

IV. Provider business mailing address

PO BOX 14395
LENEXA KS
66285-4395
US

V. Phone/Fax

Practice location:
  • Phone: 913-341-9316
  • Fax: 913-341-1198
Mailing address:
  • Phone: 913-341-9316
  • Fax: 913-341-1198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. KRISTEN IVEY
Title or Position: ACCOUNTS RECEIVABLE
Credential:
Phone: 913-341-9316