Provider Demographics
NPI:1982806790
Name:FACESON'S RESIDENTIAL-STRATFORD HOUSE
Entity Type:Organization
Organization Name:FACESON'S RESIDENTIAL-STRATFORD HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:HERELDINE
Authorized Official - Middle Name:I
Authorized Official - Last Name:FACESON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-965-5965
Mailing Address - Street 1:10724 BELLAIRE AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64134-2548
Mailing Address - Country:US
Mailing Address - Phone:816-965-5965
Mailing Address - Fax:816-965-5966
Practice Address - Street 1:10724 BELLAIRE AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64134-2548
Practice Address - Country:US
Practice Address - Phone:816-965-5965
Practice Address - Fax:816-965-5966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO320900000X320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities