Healthcare Provider Details

I. General information

NPI: 1346463908
Provider Name (Legal Business Name): AUSTEN-DOOLEY COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 SW MARKET ST
LEES SUMMIT MO
64063-2316
US

IV. Provider business mailing address

PO BOX 6530
LEES SUMMIT MO
64064-6530
US

V. Phone/Fax

Practice location:
  • Phone: 816-347-8184
  • Fax:
Mailing address:
  • Phone: 816-347-8184
  • 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 StateMO

VIII. Authorized Official

Name: KELLY M. CREEK
Title or Position: PARTNER
Credential:
Phone: 816-347-8184