Organization
ALTAR SUPPORT, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DEREK DEWAYNE VANN JR. B.S. (PRESIDENT)
(913) 915-1380
Entity
Organization
Contact information
Practice address
2750 N 87TH ST, KANSAS CITY, KS 66109-1437
(913) 915-1380
Mailing address
2750 N 87TH ST, KANSAS CITY, KS 66109-1437
(913) 915-1380
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
—
—
320700000X
Physical Disabilities Residential Treatment Facility
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
347C00000X
Private Vehicle
—
—
Other
Enumeration date
03/16/2017
Last updated
03/16/2017
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