Healthcare Provider Details

I. General information

NPI: 1962547646
Provider Name (Legal Business Name): CRITTENTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 09/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10918 ELM AVE
KANSAS CITY MO
64134-4108
US

IV. Provider business mailing address

10918 ELM AVE
KANSAS CITY MO
64134-4108
US

V. Phone/Fax

Practice location:
  • Phone: 816-765-6600
  • Fax:
Mailing address:
  • Phone: 816-765-6600
  • Fax:

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: WILLARD G STARON
Title or Position: CFO
Credential:
Phone: 816-765-6600