Provider Demographics
NPI:1295886224
Name:HARRY S. TRUMAN CHILDRENS NEUROLOGICAL CENTER
Entity type:Organization
Organization Name:HARRY S. TRUMAN CHILDRENS NEUROLOGICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FINANCE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:HURBBER
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-373-5060
Mailing Address - Street 1:15600 WOODS CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64139-1354
Mailing Address - Country:US
Mailing Address - Phone:816-373-5060
Mailing Address - Fax:816-373-5787
Practice Address - Street 1:2517 S HAWTHORNE AVE
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64052-1461
Practice Address - Country:US
Practice Address - Phone:816-252-0755
Practice Address - Fax:816-252-0735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO=========02OtherSAM II VENDOR CODE
MO8000926Medicare ID - Type Unspecified