MEDICARE: KANSAS CITY RESCUE MISSION

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	251V00000X	Voluntary or Charitable Agency

General Provider Information

NPI Number	:	1730435827
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KANSAS CITY RESCUE MISSION

Provider Business Mailing Address
First Line	:	1520 CHERRY ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64108-1530
Country	:	US
Telephone Number	:	816-421-7643
Fax Number	:	816-421-0405

Provider Business Practice Location Address
First Line	:	2611 E 11TH ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64127-1315
Country	:	US
Telephone Number	:	816-421-7643
Fax Number	:	816-421-0405

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. JOSEPH JOHN COLAIZZI
Credential	:	M.DIV.
Telephone Number	:	816-421-7643

Provider Enumeration Date	:	07/26/2012
Last Update Date	:	07/26/2012

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