Organization
DOMINICKS GROUP HOME LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS PHYLLIS ANN GREEN (ADMINISTRATOR/DIRECTOR)
(816) 623-3403
Entity
Organization
Contact information
Practice address
1112 SW WHISTLE DR, LEES SUMMIT, MO 64082-4876
(816) 623-3403
Mailing address
1112 SW WHISTLE DR, LEES SUMMIT, MO 64082-4876
(816) 623-3403
(816) 623-3403
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
N00856212
MO
Other
Enumeration date
06/11/2008
Last updated
06/11/2008
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