Provider Demographics
NPI:1154440402
Name:NORTHSTAR RESIDENTIAL CARE, INC.
Entity Type:Organization
Organization Name:NORTHSTAR RESIDENTIAL CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:BRADLEY
Authorized Official - Last Name:NORTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-795-7652
Mailing Address - Street 1:18805 HANTHORNE DR
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64057-1676
Mailing Address - Country:US
Mailing Address - Phone:816-795-7652
Mailing Address - Fax:816-795-0163
Practice Address - Street 1:1900 NW MANOR DR
Practice Address - Street 2:
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64014-1755
Practice Address - Country:US
Practice Address - Phone:816-795-7652
Practice Address - Fax:816-795-0163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities