Healthcare Provider Details

I. General information

NPI: 1740445956
Provider Name (Legal Business Name): EUNIQUE CHILD CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2008
Last Update Date: 07/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8608 E.87TH ST.
RAYTOWN MO
64138-4401
US

IV. Provider business mailing address

8608 E 87TH ST
RAYTOWN MO
64138-4401
US

V. Phone/Fax

Practice location:
  • Phone: 816-743-9910
  • Fax:
Mailing address:
  • Phone: 816-743-9910
  • 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 Number320900000X
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number385HR206OX
License Number StateMO

VIII. Authorized Official

Name: MRS. TIFFANYE SHIFFON WITCHER
Title or Position: OWNER
Credential:
Phone: 816-743-9910