MEDICARE: CENTER FOR THE 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
1	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558569103
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTER FOR THE DEVELOPMENTALLY DISABLED

Provider Business Mailing Address
First Line	:	1010 W. 39TH STREET
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	:	3704 S. BLUE RIDGE BLVD
Second Line	:
City	:	INDEPENDENCE
State	:	MO
Zip	:	64052
Country	:	US
Telephone Number	:	816-836-3462
Fax Number	:	816-836-5158

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MS. SARAH H MUDD
Credential	:
Telephone Number	:	816-531-0045

Provider Enumeration Date	:	07/05/2007
Last Update Date	:	06/07/2016

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Directions to “CENTER FOR THE DEVELOPMENTALLY DISABLED ” Practice Location

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