Provider Demographics
NPI:1538291976
Name:JACOBS WELL OF KANSAS CITY MINISTRIES
Entity Type:Organization
Organization Name:JACOBS WELL OF KANSAS CITY MINISTRIES
Other - Org Name:JACOBS WELL OF KANSAS CITY MINISTRIES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:NCC LPC
Authorized Official - Phone:816-737-2557
Mailing Address - Street 1:5921 E 31ST ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64129-1163
Mailing Address - Country:US
Mailing Address - Phone:816-737-2557
Mailing Address - Fax:
Practice Address - Street 1:5921 E 31ST ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64129-1163
Practice Address - Country:US
Practice Address - Phone:816-737-2557
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities