Provider Demographics
NPI:1720232515
Name:THE COMMUNITY OF THE GOOD SHEPHERD
Entity Type:Organization
Organization Name:THE COMMUNITY OF THE GOOD SHEPHERD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTING CLERK
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTA
Authorized Official - Middle Name:R
Authorized Official - Last Name:BAUMGARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-595-6340
Mailing Address - Street 1:10101 JAMES A REED RD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64134-2183
Mailing Address - Country:US
Mailing Address - Phone:816-595-6340
Mailing Address - Fax:816-595-6341
Practice Address - Street 1:10101 JAMES A REED RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64134-2183
Practice Address - Country:US
Practice Address - Phone:816-595-6340
Practice Address - Fax:816-595-6341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-06
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMW014114251C00000X
MOER019905495320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No251C00000XAgenciesDay Training, Developmentally Disabled Services