Provider Demographics
NPI:1518224989
Name:BETTY BILLIARD GROUP HOME
Entity type:Organization
Organization Name:BETTY BILLIARD GROUP HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:HARDEN
Authorized Official - Suffix:
Authorized Official - Credentials:MPA
Authorized Official - Phone:816-523-2988
Mailing Address - Street 1:4904 E 41ST TER
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64130-1639
Mailing Address - Country:US
Mailing Address - Phone:816-861-3840
Mailing Address - Fax:816-523-2988
Practice Address - Street 1:4904 E 41ST TER
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64130-1639
Practice Address - Country:US
Practice Address - Phone:816-861-3840
Practice Address - Fax:816-523-2988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-23
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities