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NPI Code Detail

MEDICARE: CENTER FOR DEVELOPMENTALLY DISABLED

MEDICARE: CENTER FOR DEVELOPMENTALLY DISABLED
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
1320900000XIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number : 1326171679
Entity Type Code : Organization
Provider Name (Legal Business Name) : CENTER FOR DEVELOPMENTALLY DISABLED
Provider Business Mailing Address
First Line : 1010 W 39TH ST
Second Line :
City : KANSAS CITY
State : MO
Zip : 64111-3880
Country : US
Telephone Number : 816-531-0045
Fax Number : 816-756-5612
Provider Business Practice Location Address
First Line : 1010 W 39TH ST
Second Line :
City : KANSAS CITY
State : MO
Zip : 64111-3880
Country : US
Telephone Number : 816-531-0045
Fax Number : 816-756-5612
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : MR. JIM J JOHNSON
Credential :
Telephone Number : 816-531-0045
Provider Enumeration Date : 03/14/2007
Last Update Date : 08/22/2020

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Directions to “CENTER FOR DEVELOPMENTALLY DISABLED ” Practice Location

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