MEDICARE: DISMAS HOUSE OF KANSAS CITY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency	616910679	MO

General Provider Information

NPI Number	:	1053574103
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DISMAS HOUSE OF KANSAS CITY

Provider Business Mailing Address
First Line	:	207 W LINWOOD BLVD
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64111-1327
Country	:	US
Telephone Number	:	816-531-6050
Fax Number	:

Provider Business Practice Location Address
First Line	:	207 W LINWOOD BLVD
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64111-1327
Country	:	US
Telephone Number	:	816-531-6050
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. LADELL M FLOWERS
Credential	:	M ED RSAP QP REV
Telephone Number	:	816-531-6050

Provider Enumeration Date	:	07/09/2008
Last Update Date	:	07/09/2008

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Directions to “DISMAS HOUSE OF KANSAS CITY ” Practice Location

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