Healthcare Provider Details

I. General information

NPI: 1851457469
Provider Name (Legal Business Name): MIDAMERICA ALLIANCE FOR ACCESS CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 05/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 DELAWARE ST. #102 #A
KANSAS CITY MO
64105
US

IV. Provider business mailing address

311 DELAWARE ST. #102 #A
KANSAS CITY MO
64105
US

V. Phone/Fax

Practice location:
  • Phone: 913-321-5140
  • Fax: 913-321-5140
Mailing address:
  • Phone: 913-321-5140
  • Fax: 913-321-5140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2003018091
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number01247
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: MR. DENNIS (GARRETT) GARRETT DRAKE
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 913-321-5140