Provider Demographics
NPI:1699195453
Name:BENILDE HALL PROGRAM
Entity Type:Organization
Organization Name:BENILDE HALL PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:KENT
Authorized Official - Last Name:JEWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CRADC,CCDP-D
Authorized Official - Phone:816-842-5836
Mailing Address - Street 1:3220 E 23RD ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64127-4201
Mailing Address - Country:US
Mailing Address - Phone:816-842-5836
Mailing Address - Fax:816-421-5026
Practice Address - Street 1:3220 E 23RD ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64127-4201
Practice Address - Country:US
Practice Address - Phone:816-842-5836
Practice Address - Fax:816-421-5026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-21
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1587261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder