MEDICARE: BENILDE HALL PROGRAM

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

General Provider Information

NPI Number	:	1306280896
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BENILDE HALL PROGRAM

Provider Business Mailing Address
First Line	:	3220 E 23RD ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64127-4201
Country	:	US
Telephone Number	:	816-842-5836
Fax Number	:	816-427-5026

Provider Business Practice Location Address
First Line	:	3220 E 23RD ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64127-4201
Country	:	US
Telephone Number	:	816-842-5836
Fax Number	:	816-421-5026

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. WILLIAM KENT JEWELL
Credential	:	MA, CRADC, CCDP-D
Telephone Number	:	816-842-5836

Provider Enumeration Date	:	04/26/2013
Last Update Date	:	08/28/2013

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