Organization
HOME AWAY FROM HOME HEALTHCARE FACILITY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ANGELINA MARIE REYNOLDS (CO-OWNER)
(816) 525-2470
Entity
Organization
Contact information
Practice address
13323 CRYSTAL AVE, GRANDVIEW, MO 64030-3338
(816) 525-2470
Mailing address
2004 SW KLINE AVE, LEES SUMMIT, MO 64082-4064
(816) 525-2470
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
—
Other
Enumeration date
05/14/2007
Last updated
02/28/2008
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