Organization
KANSAS CITY COMMUNITY CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MYRNA TRICKEY MPA (CEO/PRESIDENT)
(816) 421-6670
Entity
Organization
Contact information
Practice address
1534 CAMPBELL ST, KANSAS CITY, MO 64108-1520
(815) 842-1805
(816) 214-9579
Mailing address
1730 PROSPECT AVE, KANSAS CITY, MO 64127-2544
(816) 421-6670
(816) 421-4701
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
866471501
—
MO
Enumeration date
04/29/2009
Last updated
10/13/2011
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