Provider Demographics
NPI:1841770955
Name:GOODWILL OF WESTERN MISSOURI AND EASTERN KANSAS
Entity Type:Organization
Organization Name:GOODWILL OF WESTERN MISSOURI AND EASTERN KANSAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:LADA
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:816-842-7425
Mailing Address - Street 1:1817 CAMPBELL ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64108-1739
Mailing Address - Country:US
Mailing Address - Phone:816-842-7425
Mailing Address - Fax:
Practice Address - Street 1:1817 CAMPBELL ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108-1739
Practice Address - Country:US
Practice Address - Phone:816-842-7425
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-17
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No251C00000XAgenciesDay Training, Developmentally Disabled Services