Healthcare Provider Details

I. General information

NPI: 1366507659
Provider Name (Legal Business Name): HOLBROOK SISTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 05/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9206 E 44TH ST
KANSAS CITY MO
64133-1414
US

IV. Provider business mailing address

9206 E 44TH ST
KANSAS CITY MO
64133-1414
US

V. Phone/Fax

Practice location:
  • Phone: 816-356-5556
  • Fax: 816-356-5556
Mailing address:
  • Phone: 816-356-5556
  • Fax: 816-356-5556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateMO

VIII. Authorized Official

Name: DIANA JO MANGE
Title or Position: BOARD CHAIRPERSON
Credential:
Phone: 816-517-4104