Healthcare Provider Details

I. General information

NPI: 1740503978
Provider Name (Legal Business Name): NORTHWEST REGIONAL YOUTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2010
Last Update Date: 03/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4901 NE BARRY RD
KANSAS CITY MO
64156-1219
US

IV. Provider business mailing address

4901 NE BARRY RD
KANSAS CITY MO
64156-1219
US

V. Phone/Fax

Practice location:
  • Phone: 816-437-3656
  • Fax: 816-437-3660
Mailing address:
  • Phone: 816-437-3656
  • Fax: 816-437-3660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. SONDRA GAYNELLE HAWK
Title or Position: LPN II
Credential: LPN
Phone: 816-437-3656