=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083921514
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CASS COUNTY CENTER FOR SENIORS & SPECIAL NEEDS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/03/2010
-----------------------------------------------------
Last Update Date | 05/27/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 414 REMINGTON PLAZA CT
-----------------------------------------------------
City | RAYMORE
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64083-8599
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-331-6565
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 414 REMINGTON PLAZA CT
-----------------------------------------------------
City | RAYMORE
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64083-8599
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-331-6565
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | AISHA LADI WASHINGTON
-----------------------------------------------------
Credential | MS,RD,LD
-----------------------------------------------------
Telephone | 816-331-6565
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA0600X
-----------------------------------------------------
Taxonomy Name | Adult Day Care Clinic/Center
-----------------------------------------------------
License Number | 882
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------