Provider Demographics
NPI:1851650527
Name:COMMON GROUND FARMSTEAD LLC
Entity Type:Organization
Organization Name:COMMON GROUND FARMSTEAD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:HUNTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-284-9926
Mailing Address - Street 1:6151 NE 352ND ST
Mailing Address - Street 2:
Mailing Address - City:OSBORN
Mailing Address - State:MO
Mailing Address - Zip Code:64474-7301
Mailing Address - Country:US
Mailing Address - Phone:816-284-9926
Mailing Address - Fax:
Practice Address - Street 1:6151 NE 352ND ST
Practice Address - Street 2:
Practice Address - City:OSBORN
Practice Address - State:MO
Practice Address - Zip Code:64474-7301
Practice Address - Country:US
Practice Address - Phone:816-284-9926
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-15
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities