Provider Demographics
NPI:1043536626
Name:KANSAS CITY COMMUNITY CENTER
Entity Type:Organization
Organization Name:KANSAS CITY COMMUNITY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS MPA
Authorized Official - Phone:816-421-6670
Mailing Address - Street 1:1730 PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64127-2544
Mailing Address - Country:US
Mailing Address - Phone:816-421-6670
Mailing Address - Fax:816-421-4701
Practice Address - Street 1:622 BENTON BLVD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64124-2559
Practice Address - Country:US
Practice Address - Phone:816-421-6670
Practice Address - Fax:816-842-1835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-08
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1053587469Medicaid