Provider Demographics
NPI:1740503978
Name:NORTHWEST REGIONAL YOUTH CENTER
Entity type:Organization
Organization Name:NORTHWEST REGIONAL YOUTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPN II
Authorized Official - Prefix:MS
Authorized Official - First Name:SONDRA
Authorized Official - Middle Name:GAYNELLE
Authorized Official - Last Name:HAWK
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:816-437-3656
Mailing Address - Street 1:4901 NE BARRY RD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64156-1219
Mailing Address - Country:US
Mailing Address - Phone:816-437-3656
Mailing Address - Fax:816-437-3660
Practice Address - Street 1:4901 NE BARRY RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64156-1219
Practice Address - Country:US
Practice Address - Phone:816-437-3656
Practice Address - Fax:816-437-3660
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STATE OF MISSOURI
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-03-02
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children