Healthcare Provider Details

I. General information

NPI: 1073714614
Provider Name (Legal Business Name): REACHING OUT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8716 LONGVIEW CT
KANSAS CITY MO
64134-3674
US

IV. Provider business mailing address

8716 LONGVIEW CT
KANSAS CITY MO
64134-3674
US

V. Phone/Fax

Practice location:
  • Phone: 816-678-3522
  • Fax: 816-765-0680
Mailing address:
  • Phone: 816-678-3522
  • Fax: 816-765-0680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State

VIII. Authorized Official

Name: MR. DEREK LAMONTE SPRUILL SR.
Title or Position: DIRECTOR
Credential:
Phone: 816-678-3522