Healthcare Provider Details

I. General information

NPI: 1760671861
Provider Name (Legal Business Name): COMMUNITY CHOICE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2007
Last Update Date: 11/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4218 ROANOKE RD STE 210
KANSAS CITY MO
64111-4983
US

IV. Provider business mailing address

4218 ROANOKE RD STE 210
KANSAS CITY MO
64111-4983
US

V. Phone/Fax

Practice location:
  • Phone: 816-756-3397
  • Fax: 816-756-3320
Mailing address:
  • Phone: 816-756-3397
  • Fax: 816-756-3320

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
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number StateMO

VIII. Authorized Official

Name: MR. SCOTT T SHEPHERD
Title or Position: PRESIDENT
Credential:
Phone: 816-756-3397