1942348164 NPI number — COMMUNITY SUPPORT PARTNERS

Table of content: (NPI 1942348164)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942348164 NPI number — COMMUNITY SUPPORT PARTNERS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMUNITY SUPPORT PARTNERS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1942348164
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/09/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10330 HICKMAN MILLS DR
Provider Second Line Business Mailing Address:
BLDG 2
Provider Business Mailing Address City Name:
KANSAS CITY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64137-1618
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-777-1301
Provider Business Mailing Address Fax Number:
816-777-1305

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
505 N BYNUM RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LONE JACK
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64070-9589
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-777-1301
Provider Business Practice Location Address Fax Number:
816-777-1305
Provider Enumeration Date:
02/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ROYER
Authorized Official First Name:
CORY
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
816-777-1301

Provider Taxonomy Codes

  • Taxonomy code: 320600000X , with the licence number:  6450-9633 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 856272703 . This is a "PROVIDER NUMBER" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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