Healthcare Provider Details

I. General information

NPI: 1932839461
Provider Name (Legal Business Name): THE HALO FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2022
Last Update Date: 07/07/2022
Certification Date: 07/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3519 BENNETT LN
JEFFERSON CITY MO
65101-1001
US

IV. Provider business mailing address

1600 GENESSEE ST STE 200
KANSAS CITY MO
64102-1010
US

V. Phone/Fax

Practice location:
  • Phone: 573-418-9912
  • Fax:
Mailing address:
  • Phone: 816-472-4256
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: CARLY SCHULTZE
Title or Position: CHIEF PROGRAM OFFICER
Credential:
Phone: 816-472-4256