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General NPI Number Information
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NPI Number | 1407037179
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Entity Type | Organization
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Legal Business Name | JOLET II, INCORPORATED
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Dates
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Enumeration Date | 11/21/2007
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Last Update Date | 11/21/2007
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Provider Practice Location Address
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Address Line | 3920 FOREST AVE
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City | KANSAS CITY
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State | MO
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Zip | 64110-1220
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Country | US
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Telephone | 816-861-5189
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Fax | 816-921-4259
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Provider Business Mailing Address
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Address Line | 3920 FOREST AVE
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City | KANSAS CITY
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State | MO
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Zip | 64110-1220
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Country | US
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Telephone | 816-861-5189
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Fax | 816-921-4259
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | RONALD K THOMPSON
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Credential |
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Telephone | 816-861-5189
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number | 033218
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License Number State | MO
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