Basic Information
| Provider Information | |||||||||
| NPI: | 1518096528 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THE COMMUNITY OF THE GOOD SHEPHERD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10101 JAMES A REED RD | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641342183 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8167678090 | ||||||||
| FaxNumber: | 8167678091 | ||||||||
| Practice Location | |||||||||
| Address1: | 10101 JAMES A REED RD | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641342183 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8167678090 | ||||||||
| FaxNumber: | 8167678091 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/05/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | BAUMGARDNER | ||||||||
| AuthorizedOfficialFirstName: | KRISTA | ||||||||
| AuthorizedOfficialMiddleName: | RENEE' | ||||||||
| AuthorizedOfficialTitleorPosition: | ACCOUNTING CLERK | ||||||||
| AuthorizedOfficialTelephone: | 8167678090 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 320900000X | MO | Y | Residential Treatment Facilities | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities |
No ID Information.