Provider Demographics
NPI:1376681650
Name:COMMUNITY SUPPORT PARTNERS
Entity Type:Organization
Organization Name:COMMUNITY SUPPORT PARTNERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CORY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-777-1301
Mailing Address - Street 1:10330 HICKMAN MILLS DR
Mailing Address - Street 2:BLDG 2
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64137-1618
Mailing Address - Country:US
Mailing Address - Phone:816-777-1301
Mailing Address - Fax:816-777-1305
Practice Address - Street 1:8600 E 74TH ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64133-6318
Practice Address - Country:US
Practice Address - Phone:816-777-1301
Practice Address - Fax:816-777-1305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO6368-9311320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO856252903OtherPROVIDER NUMBER