Healthcare Provider Details

I. General information

NPI: 1255516621
Provider Name (Legal Business Name): MERRICK CARE CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2008
Last Update Date: 01/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 20TH AVE S
GREENWOOD MO
64034-8611
US

IV. Provider business mailing address

100 20TH AVE S
GREENWOOD MO
64034-8611
US

V. Phone/Fax

Practice location:
  • Phone: 816-588-2950
  • Fax: 816-537-4155
Mailing address:
  • Phone: 816-588-2950
  • Fax: 816-537-4155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License NumberN00848755
License Number StateMO

VIII. Authorized Official

Name: MR. URUM O URUM-EKE
Title or Position: OWNER/ADMINISTRATOR
Credential:
Phone: 816-588-2950