Healthcare Provider Details

I. General information

NPI: 1275731820
Provider Name (Legal Business Name): CENTER FOR THE DEVELOPMENTALLY DISABLED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2007
Last Update Date: 06/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11228 MILITARY CLUB RD
KANSAS CITY MO
64138
US

IV. Provider business mailing address

1010 W. 39TH STREET
KANSAS CITY MO
64111-3880
US

V. Phone/Fax

Practice location:
  • Phone: 816-836-3462
  • Fax: 816-836-5158
Mailing address:
  • Phone: 816-531-0045
  • Fax: 816-756-5612

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 State

VIII. Authorized Official

Name: MS. SARAH H MUDD
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 816-531-0045