Provider Demographics
NPI:1972857688
Name:CARLA MARIE AVERY-HUTCHINS
Entity Type:Organization
Organization Name:CARLA MARIE AVERY-HUTCHINS
Other - Org Name:ACJC DAY RESIDENTIAL CARLA LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:AVERY-HUTCHINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-392-9878
Mailing Address - Street 1:10606 E 34TH ST S
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64052-2624
Mailing Address - Country:US
Mailing Address - Phone:816-392-9878
Mailing Address - Fax:
Practice Address - Street 1:12420 W 119TH TER APT 714
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66213-5727
Practice Address - Country:US
Practice Address - Phone:913-766-3400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-02
Last Update Date:2013-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS251C00000X, 320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities