Organization
DICKERSON ISL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHARLES RAY DICKERSON (PROVIDER)
(816) 353-8850
Entity
Organization
Contact information
Practice address
9401 E 90TH TER, KANSAS CITY, MO 64138-4770
(816) 353-8850
Mailing address
9401 E 90TH TER, KANSAS CITY, MO 64138-4770
(816) 353-8850
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
9227
MO
Other
Enumeration date
04/14/2008
Last updated
04/14/2008
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