Organization
ADULT LIFE CARE CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHANTIC BANDY (DIRECTOR)
(816) 266-3057
Entity
Organization
Contact information
Practice address
11517 HICKMAN MILLS DR # AB, KANSAS CITY, MO 64134-4210
(816) 844-9374
Mailing address
8607 MAPLE AVE, RAYTOWN, MO 64138-3358
(816) 266-3057
Taxonomy
Speciality
Code
Description
License number
State
261QA0600X
Adult Day Care Clinic/Center
Primary
1443
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1443
ADULT DAY CARE LICENSE NUMBER
MO
Enumeration date
09/01/2017
Last updated
09/01/2017
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