Organization
ALYCE D. CLARK
Active
Other names
Shepherd's Lane
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ALYCE DENISE CLARK RN, BSN (OWNER)
(816) 943-1300
Entity
Organization
Contact information
Practice address
10640 HOLMES ROAD, KANSAS CITY, MO 64131-3404
(816) 943-1300
(816) 942-7443
Mailing address
10640 HOLMES RD, KANSAS CITY, MO 64131-3404
(816) 943-1300
(816) 942-7443
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
856274402
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8002103
DMH VENDOR NUMBER
MO
05
—
856274402
—
MO
Enumeration date
03/27/2007
Last updated
07/29/2008
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