Provider Demographics
NPI:1023136165
Name:CHILDREN'S CENTER FOR THE VISUALLY IMPAIRED
Entity type:Organization
Organization Name:CHILDREN'S CENTER FOR THE VISUALLY IMPAIRED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:SHAWN
Authorized Official - Last Name:BOEHM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-841-2284
Mailing Address - Street 1:3101 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-1921
Mailing Address - Country:US
Mailing Address - Phone:816-841-2284
Mailing Address - Fax:
Practice Address - Street 1:3101 MAIN ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-1921
Practice Address - Country:US
Practice Address - Phone:816-841-2284
Practice Address - Fax:816-753-7836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MON00007354251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO506282101Medicaid