Healthcare Provider Details

I. General information

NPI: 1225546724
Provider Name (Legal Business Name): URBAN OUTREACH MINISTRIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2018
Last Update Date: 01/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11926 E 44TH TER
KANSAS CITY MO
64133-2005
US

IV. Provider business mailing address

11926 E 44TH TER
KANSAS CITY MO
64133-2005
US

V. Phone/Fax

Practice location:
  • Phone: 816-674-9183
  • Fax:
Mailing address:
  • Phone: 816-674-9183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number StateMO

VIII. Authorized Official

Name: TIMOTHY JOHNSON
Title or Position: OWNER
Credential:
Phone: 816-674-9183