Healthcare Provider Details

I. General information

NPI: 1962995993
Provider Name (Legal Business Name): THE BRIDGE HOME FOR CHILDREN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2018
Last Update Date: 06/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6033 SWOPE PKWY
KANSAS CITY MO
64130-4461
US

IV. Provider business mailing address

6033 SWOPE PKWY
KANSAS CITY MO
64130-4461
US

V. Phone/Fax

Practice location:
  • Phone: 816-333-8711
  • Fax: 816-333-8799
Mailing address:
  • Phone: 816-333-8711
  • Fax: 816-333-8799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. BEVERLY JEAN WATSON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 816-333-8711