MEDICARE: SUPPORTING HEARTS

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	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1053584268
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUPPORTING HEARTS

Provider Business Mailing Address
First Line	:	3231 ROBERTS ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64124-1927
Country	:	US
Telephone Number	:	816-241-0465
Fax Number	:	816-241-0465

Provider Business Practice Location Address
First Line	:	7344 INDIANA AVE
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64132-1912
Country	:	US
Telephone Number	:	816-241-0465
Fax Number	:

Authorized Official
Title or Position	:	CO-DIRECTOR
Name	:	MARSCHELLE TRE'NICCE HORTON
Credential	:
Telephone Number	:	816-359-9202

Provider Enumeration Date	:	04/08/2008
Last Update Date	:	04/08/2008

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Directions to “SUPPORTING HEARTS ” Practice Location

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