Organization
CASS-WAY, LLC
Active
Other names
J & L Farm, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL MATUKEWICZ (OWNER/PROFESSIONAL MANAGER)
(816) 716-6135
Entity
Organization
Contact information
Practice address
17512 S REYNOLDS RD, PLEASANT HILL, MO 64080-9342
(816) 803-5153
(816) 817-0612
Mailing address
17512 S REYNOLDS RD, PLEASANT HILL, MO 64080
(816) 803-5153
(816) 817-0612
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
210-336-76
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
WC1-0364-1011
—
MO
Enumeration date
12/08/2016
Last updated
12/08/2016
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