Provider Demographics
NPI:1093852402
Name:COMMUNITY RECREATION & RESOCIALIZATION
Entity Type:Organization
Organization Name:COMMUNITY RECREATION & RESOCIALIZATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:C
Authorized Official - Last Name:GOODDING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-233-0430
Mailing Address - Street 1:525 S 10TH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64501-2725
Mailing Address - Country:US
Mailing Address - Phone:816-233-0430
Mailing Address - Fax:816-233-3795
Practice Address - Street 1:525 S 10TH ST
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64501-2725
Practice Address - Country:US
Practice Address - Phone:816-233-0430
Practice Address - Fax:816-233-3795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1739569251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services