Provider Demographics
NPI:1528232600
Name:MORGAN MANOR
Entity Type:Organization
Organization Name:MORGAN MANOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT - ADMIN. OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-353-5274
Mailing Address - Street 1:9515 E 32ND ST S
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64052-1002
Mailing Address - Country:US
Mailing Address - Phone:816-353-5274
Mailing Address - Fax:816-353-1226
Practice Address - Street 1:11212 E 71ST ST
Practice Address - Street 2:
Practice Address - City:RAYTOWN
Practice Address - State:MO
Practice Address - Zip Code:64133-6801
Practice Address - Country:US
Practice Address - Phone:816-353-5274
Practice Address - Fax:816-353-1226
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KMW,INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-18
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental DisabilitiesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO=========Medicare UPIN