Provider Demographics
NPI:1255785531
Name:KANSAS CITY BEHAVIORAL HEALTH HOLDCO
Entity type:Organization
Organization Name:KANSAS CITY BEHAVIORAL HEALTH HOLDCO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:DUCKWORTH-HAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-877-2005
Mailing Address - Street 1:411 NICHOLS RD
Mailing Address - Street 2:SUITE 217
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64112-2000
Mailing Address - Country:US
Mailing Address - Phone:816-877-2005
Mailing Address - Fax:
Practice Address - Street 1:10330 HICKMAN MILLS DR
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64137-1618
Practice Address - Country:US
Practice Address - Phone:816-877-2005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-22
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO251S00000X, 320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No251S00000XAgenciesCommunity/Behavioral Health