Provider Demographics
NPI:1861845711
Name:CREATIVE SUPPORTS OF KANSAS CITY, LLC
Entity Type:Organization
Organization Name:CREATIVE SUPPORTS OF KANSAS CITY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:GUYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-389-6050
Mailing Address - Street 1:6500 NW TOWER DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:PLATTE WOODS
Mailing Address - State:MO
Mailing Address - Zip Code:64151-4463
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6500 NW TOWER DR
Practice Address - Street 2:SUITE B
Practice Address - City:PLATTE WOODS
Practice Address - State:MO
Practice Address - Zip Code:64151-4463
Practice Address - Country:US
Practice Address - Phone:816-389-6050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-15
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities