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General NPI Number Information
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NPI Number | 1861311797
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Entity Type | Organization
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Legal Business Name | PROVIDENCE SUPPORT SERVICES LLC
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Dates
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Enumeration Date | 07/14/2026
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Last Update Date | 07/14/2026
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Provider Practice Location Address
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Address Line | 6204 NE NORMANDY DR
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City | KANSAS CITY
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State | MO
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Zip | 64118-4826
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Country | US
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Telephone | 913-404-9848
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Fax | 913-884-1720
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Provider Business Mailing Address
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Address Line | 312 SW GREENWICH DR
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City | LEES SUMMIT
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State | MO
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Zip | 64082-4408
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Country | US
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Telephone | 913-404-9848
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Fax | 913-884-1720
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | THERESIA MUSHI
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Credential | MSN, ARNP, PMHNP-BC
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Telephone | 913-404-9848
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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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