Provider Demographics
NPI:1205030699
Name:SERC HAND OF CASS COUNTY L.L.C.
Entity Type:Organization
Organization Name:SERC HAND OF CASS COUNTY L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, MANAGER, THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:G
Authorized Official - Last Name:HARNDEN
Authorized Official - Suffix:
Authorized Official - Credentials:OTR-L, CHT
Authorized Official - Phone:816-318-0436
Mailing Address - Street 1:17134 BEL RAY PL
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:MO
Mailing Address - Zip Code:64012-5331
Mailing Address - Country:US
Mailing Address - Phone:816-318-0436
Mailing Address - Fax:816-318-0437
Practice Address - Street 1:17134 BEL RAY PL
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:MO
Practice Address - Zip Code:64012-5331
Practice Address - Country:US
Practice Address - Phone:816-318-0436
Practice Address - Fax:816-318-0437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006025819332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO38514011OtherBKCS
MOX600000Medicare PIN