Organization
MULBERRY STREET LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DIANE MARIE MACK (PRESIDENT)
(816) 224-2000
Entity
Organization
Contact information
Practice address
1519 SW STATE ROUTE 7, BLUE SPRINGS, MO 64014-3944
(816) 224-2000
Mailing address
1519 SW STATE ROUTE 7, BLUE SPRINGS, MO 64014-3944
(816) 224-2000
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
08/22/2007
Last updated
01/07/2013
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