Provider Demographics
NPI:1689830119
Name:COLA'S PLACE
Entity Type:Organization
Organization Name:COLA'S PLACE
Other - Org Name:COLA'S PLACE NORTH
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:AMATHA
Authorized Official - Middle Name:MONICA
Authorized Official - Last Name:ELLIOTT-GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-920-6084
Mailing Address - Street 1:420 CYPRESS AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64124-2145
Mailing Address - Country:US
Mailing Address - Phone:816-920-6084
Mailing Address - Fax:816-920-6084
Practice Address - Street 1:6507 NW HILLDALE DR
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64151-2328
Practice Address - Country:US
Practice Address - Phone:816-587-8317
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-04
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO855991907Medicaid