Healthcare Provider Details

I. General information

NPI: 1619786613
Provider Name (Legal Business Name): CENTER FOR THE DEVELOPMENTALLY DISABLED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2025
Last Update Date: 01/03/2025
Certification Date: 12/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9150 E 41ST TER
KANSAS CITY MO
64133-1448
US

IV. Provider business mailing address

9150 E 41ST TER
KANSAS CITY MO
64133-1448
US

V. Phone/Fax

Practice location:
  • Phone: 816-531-0045
  • Fax: 816-756-5612
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: SARAH MUDD
Title or Position: CEO
Credential:
Phone: 816-531-0045