Healthcare Provider Details

I. General information

NPI: 1043382740
Provider Name (Legal Business Name): INTERFAITH COMMUNITY SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 01/12/2024
Certification Date: 01/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 KING HILL AVE
SAINT JOSEPH MO
64504-1503
US

IV. Provider business mailing address

5400 KING HILL AVE
SAINT JOSEPH MO
64504-1503
US

V. Phone/Fax

Practice location:
  • Phone: 816-238-4511
  • Fax: 816-232-7029
Mailing address:
  • Phone: 816-238-4511
  • Fax: 816-232-7029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number StateMO

VIII. Authorized Official

Name: BRIDGET SUPPLE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 816-238-4511