Healthcare Provider Details

I. General information

NPI: 1083921514
Provider Name (Legal Business Name): CASS COUNTY CENTER FOR SENIORS & SPECIAL NEEDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2010
Last Update Date: 05/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 REMINGTON PLAZA CT
RAYMORE MO
64083-8599
US

IV. Provider business mailing address

414 REMINGTON PLAZA CT
RAYMORE MO
64083-8599
US

V. Phone/Fax

Practice location:
  • Phone: 816-331-6565
  • Fax:
Mailing address:
  • Phone: 816-331-6565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number882
License Number StateMO

VIII. Authorized Official

Name: AISHA LADI WASHINGTON
Title or Position: CEO
Credential: MS,RD,LD
Phone: 816-331-6565