Provider Demographics
NPI:1366507659
Name:HOLBROOK SISTERS, INC.
Entity Type:Organization
Organization Name:HOLBROOK SISTERS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD CHAIRPERSON
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:JO
Authorized Official - Last Name:MANGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-517-4104
Mailing Address - Street 1:9206 E 44TH ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64133-1414
Mailing Address - Country:US
Mailing Address - Phone:816-356-5556
Mailing Address - Fax:816-356-5556
Practice Address - Street 1:9206 E 44TH ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64133-1414
Practice Address - Country:US
Practice Address - Phone:816-356-5556
Practice Address - Fax:816-356-5556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO251E00000X
320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO856164207Medicaid
MO856164215Medicaid
MO266237403Medicaid
MO286237409Medicaid