Organization
SUPPORT PROFESSIONALS II
Active
Other names
Support Professionals
Organization subpart
No
Provider details
NPI number
Authorized official
PATRICE VERAGUTH (ADMINISTRATOR)
(816) 898-7529
Entity
Organization
Contact information
Practice address
8540 BLUE RIDGE, KANSAS CITY, MO 64138
(816) 759-0112
Mailing address
8540 BLUE RIDGE, KANSAS CITY, MO 64138
(816) 759-0112
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
06/06/2012
Last updated
06/06/2012
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