Provider Demographics
NPI:1477733475
Name:MIDLAND EMPIRE RESOURCES FOR INDEPENDENT LIVING
Entity Type:Organization
Organization Name:MIDLAND EMPIRE RESOURCES FOR INDEPENDENT LIVING
Other - Org Name:MERIL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:J.C.
Authorized Official - Middle Name:
Authorized Official - Last Name:DOLLAR
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, MDIV
Authorized Official - Phone:816-279-8558
Mailing Address - Street 1:4420 S 40TH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64503-2157
Mailing Address - Country:US
Mailing Address - Phone:816-279-8558
Mailing Address - Fax:816-279-1550
Practice Address - Street 1:4420 S 40TH ST
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64503-2157
Practice Address - Country:US
Practice Address - Phone:816-279-8558
Practice Address - Fax:816-279-1550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-07
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO139089261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service