Provider Demographics
NPI:1093854606
Name:CENTER SCHOOL DISTRICT 58
Entity Type:Organization
Organization Name:CENTER SCHOOL DISTRICT 58
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPECIAL SERVICES SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-349-3307
Mailing Address - Street 1:8701 HOLMES RD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131-2802
Mailing Address - Country:US
Mailing Address - Phone:816-349-3300
Mailing Address - Fax:816-349-3678
Practice Address - Street 1:8701 HOLMES RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64131-2802
Practice Address - Country:US
Practice Address - Phone:816-349-3300
Practice Address - Fax:816-349-3678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251300000XAgenciesLocal Education Agency (LEA)
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO506199009Medicaid