Provider Demographics
NPI:1871636795
Name:BETTY BILLIARD GROUP HOME
Entity Type:Organization
Organization Name:BETTY BILLIARD GROUP HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:J
Authorized Official - Last Name:BILLIARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-861-3840
Mailing Address - Street 1:4904 E 41ST TERRACE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64130
Mailing Address - Country:US
Mailing Address - Phone:816-861-3840
Mailing Address - Fax:
Practice Address - Street 1:4904 E 41ST TERRACE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64130
Practice Address - Country:US
Practice Address - Phone:816-861-3840
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty