Healthcare Provider Details

I. General information

NPI: 1962699397
Provider Name (Legal Business Name): SELECTRA ONESOURCE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2007
Last Update Date: 03/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11922 FOOD LN
GRANDVIEW MO
64030-1335
US

IV. Provider business mailing address

1734 E 63RD ST 448
KANSAS CITY MO
64110-3543
US

V. Phone/Fax

Practice location:
  • Phone: 816-822-1000
  • Fax: 816-822-1040
Mailing address:
  • Phone: 816-822-1000
  • Fax: 816-822-1040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. SHANIA LATRICE WRIGHT
Title or Position: DIRECTOR
Credential:
Phone: 816-822-1000