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NPI Code Detail

MEDICARE: PEP PHYSICAL & EMOTIONAL POWER FOR LIFE, LLC

MEDICARE: PEP PHYSICAL & EMOTIONAL POWER FOR LIFE, LLC
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
1251S00000XCommunity/Behavioral Health Agency2387KS
2251S00000XCommunity/Behavioral Health Agency2003022197MO

General Provider Information

NPI Number : 1972811578
Entity Type Code : Organization
Provider Name (Legal Business Name) : PEP PHYSICAL & EMOTIONAL POWER FOR LIFE, LLC
Provider Business Mailing Address
First Line : 7280 NW 87TH TER
Second Line : #210
City : KANSAS CITY
State : MO
Zip : 64153-3720
Country : US
Telephone Number : 816-872-2463
Fax Number : 816-533-7220
Provider Business Practice Location Address
First Line : 7280 NW 87TH TER
Second Line : #210
City : KANSAS CITY
State : MO
Zip : 64153-3720
Country : US
Telephone Number : 816-872-2463
Fax Number : 816-533-7220
Authorized Official
Title or Position : OWNER
Name : JACQUELINE KEITEL
Credential : LSCSW, LCSW
Telephone Number : 816-872-2463
Provider Enumeration Date : 09/16/2010
Last Update Date : 10/05/2010

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Directions to “PEP PHYSICAL & EMOTIONAL POWER FOR LIFE, LLC ” Practice Location

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