Provider Demographics
NPI:1881895399
Name:JACKSON COUNTY, MISSOURI
Entity type:Organization
Organization Name:JACKSON COUNTY, MISSOURI
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:JONES
Authorized Official - Last Name:MCMILLAN
Authorized Official - Suffix:
Authorized Official - Credentials:CTRS
Authorized Official - Phone:816-763-5130
Mailing Address - Street 1:10700 EAST 109TH STREET
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64134-4103
Mailing Address - Country:US
Mailing Address - Phone:816-763-5130
Mailing Address - Fax:816-763-5302
Practice Address - Street 1:10700 EAST 109TH STREET
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64134-4103
Practice Address - Country:US
Practice Address - Phone:816-763-5130
Practice Address - Fax:816-763-5302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1523-8617251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO856794102Medicaid