Provider Demographics
NPI:1770859324
Name:OUR HOUSE MY HOUSE KC, INC.
Entity Type:Organization
Organization Name:OUR HOUSE MY HOUSE KC, INC.
Other - Org Name:OUR HOUSE OF KC, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PROVIDER/ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MAYLON
Authorized Official - Middle Name:D
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-737-8628
Mailing Address - Street 1:9406 E 63RD ST STE B
Mailing Address - Street 2:
Mailing Address - City:RAYTOWN
Mailing Address - State:MO
Mailing Address - Zip Code:64133-4950
Mailing Address - Country:US
Mailing Address - Phone:816-737-8628
Mailing Address - Fax:816-737-1064
Practice Address - Street 1:9406 E 63RD ST STE B
Practice Address - Street 2:
Practice Address - City:RAYTOWN
Practice Address - State:MO
Practice Address - Zip Code:64133-4950
Practice Address - Country:US
Practice Address - Phone:816-737-8628
Practice Address - Fax:816-737-1064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-28
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOWC1-0190-1211251C00000X, 320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No251C00000XAgenciesDay Training, Developmentally Disabled Services