Healthcare Provider Details

I. General information

NPI: 1528110921
Provider Name (Legal Business Name): CASS COUNTY COMMUNITY LIVING INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1909 S JEFFERSON PKWY
HARRISONVILLE MO
64701-3712
US

IV. Provider business mailing address

1909 S JEFFERSON PKWY P.O. BOX 375
HARRISONVILLE MO
64701-3712
US

V. Phone/Fax

Practice location:
  • Phone: 816-380-6322
  • Fax:
Mailing address:
  • Phone: 816-380-6322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. CARLA YAVONNE TALCOTT
Title or Position: DIRECTOR
Credential:
Phone: 816-380-6322