Provider Demographics
NPI:1003000571
Name:HOUSE OF CARE CENTER
Entity Type:Organization
Organization Name:HOUSE OF CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PHILOMINA
Authorized Official - Middle Name:NONYEREM
Authorized Official - Last Name:IKPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-921-6852
Mailing Address - Street 1:3744 BENTON BLVD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64128-2515
Mailing Address - Country:US
Mailing Address - Phone:816-921-6852
Mailing Address - Fax:
Practice Address - Street 1:3744 BENTON BLVD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64128-2515
Practice Address - Country:US
Practice Address - Phone:816-921-6852
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-28
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO034007323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility