Healthcare Provider Details

I. General information

NPI: 1497008213
Provider Name (Legal Business Name): DEVELOPING POTENTIAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2012
Last Update Date: 02/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 W WALNUT ST
INDEPENDENCE MO
64050-3846
US

IV. Provider business mailing address

120 W WALNUT ST
INDEPENDENCE MO
64050-3846
US

V. Phone/Fax

Practice location:
  • Phone: 816-252-0086
  • Fax: 816-525-6003
Mailing address:
  • Phone: 816-252-0086
  • Fax: 816-525-6003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. REBECCA CASE
Title or Position: EXECUTIVE DIRECTOR
Credential: MSM
Phone: 816-914-6843