Provider Demographics
NPI:1366640914
Name:CENTER FOR THE DEVELOPMENTALLY DISABLED
Entity Type:Organization
Organization Name:CENTER FOR THE DEVELOPMENTALLY DISABLED
Other - Org Name:SPECIAL NEIGHBORS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:H
Authorized Official - Last Name:MUDD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-531-0045
Mailing Address - Street 1:1010 W. 39TH STREET
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-3880
Mailing Address - Country:US
Mailing Address - Phone:816-531-0045
Mailing Address - Fax:816-756-5612
Practice Address - Street 1:1215 W. TRUMAN RD
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64050
Practice Address - Country:US
Practice Address - Phone:816-836-3462
Practice Address - Fax:816-836-5158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-05
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO853351203Medicaid