Provider Demographics
NPI:1386868297
Name:EAGLE HEIGHTS ISL SERVICES
Entity Type:Organization
Organization Name:EAGLE HEIGHTS ISL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:QMRP
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:JUDITH
Authorized Official - Last Name:DEMPSEY
Authorized Official - Suffix:
Authorized Official - Credentials:CTRS
Authorized Official - Phone:816-765-1185
Mailing Address - Street 1:PO BOX 560
Mailing Address - Street 2:
Mailing Address - City:BELRON
Mailing Address - State:MO
Mailing Address - Zip Code:64012
Mailing Address - Country:US
Mailing Address - Phone:816-765-1185
Mailing Address - Fax:816-765-1185
Practice Address - Street 1:8905 CAMBRIDGE AVE
Practice Address - Street 2:APT 2202
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64138
Practice Address - Country:US
Practice Address - Phone:816-965-0701
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities