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General NPI Number Information
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NPI Number | 1518224989
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Entity Type | Organization
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Legal Business Name | BETTY BILLIARD GROUP HOME
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Dates
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Enumeration Date | 04/23/2012
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Last Update Date | 04/23/2012
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Provider Practice Location Address
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Address Line | 4904 E 41ST TER
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City | KANSAS CITY
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State | MO
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Zip | 64130-1639
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Country | US
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Telephone | 816-861-3840
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Fax | 816-523-2988
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Provider Business Mailing Address
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Address Line | 4904 E 41ST TER
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City | KANSAS CITY
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State | MO
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Zip | 64130-1639
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Country | US
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Telephone | 816-861-3840
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Fax | 816-523-2988
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. EVELYN HARDEN
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Credential | MPA
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Telephone | 816-523-2988
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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