Provider Demographics
NPI:1164601357
Name:CARE BY CASSIE
Entity Type:Organization
Organization Name:CARE BY CASSIE
Other - Org Name:CARE BY CLARK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CASSANDRA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:CLARK WHEELER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-847-0931
Mailing Address - Street 1:4230 S PHELPS RD
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-5067
Mailing Address - Country:US
Mailing Address - Phone:816-478-9031
Mailing Address - Fax:816-350-3406
Practice Address - Street 1:3816 S UNION ST
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-3150
Practice Address - Country:US
Practice Address - Phone:816-478-9031
Practice Address - Fax:816-350-3406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-24
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO14109246320900000X
MO1410-9246320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO859720203Medicaid
MO858953102Medicaid
MO858191901Medicaid