Provider Demographics
NPI:1750323192
Name:EATING DISORDERS PROGRAM OF KANSAS CITY, LLC
Entity Type:Organization
Organization Name:EATING DISORDERS PROGRAM OF KANSAS CITY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MIMI
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIMMERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:816-942-1811
Mailing Address - Street 1:400 E RED BRIDGE RD
Mailing Address - Street 2:SUITE 304
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131-4035
Mailing Address - Country:US
Mailing Address - Phone:816-942-1811
Mailing Address - Fax:816-942-0419
Practice Address - Street 1:400 E RED BRIDGE RD
Practice Address - Street 2:SUITE 304
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64131-4035
Practice Address - Country:US
Practice Address - Phone:816-942-1811
Practice Address - Fax:816-942-0419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO13005012OtherBCBSKC
MO13005012OtherBCBSKC