MEDICARE: GREATER KANSAS CITY FOUNDATION FOR CITIZENS WITH DISABILITIES

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	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility		MO

General Provider Information

NPI Number	:	1609066968
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREATER KANSAS CITY FOUNDATION FOR CITIZENS WITH DISABILITIES

Provider Business Mailing Address
First Line	:	4111 E 100TH TERRACE
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64137-1403
Country	:	US
Telephone Number	:	816-931-4694
Fax Number	:	816-931-3455

Provider Business Practice Location Address
First Line	:	4111 E 100TH TERRACE
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64137-1403
Country	:	US
Telephone Number	:	816-931-4694
Fax Number	:	816-931-3455

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	SHARON A TIGNER
Credential	:
Telephone Number	:	816-931-4694

Provider Enumeration Date	:	08/01/2007
Last Update Date	:	08/01/2007

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