MRACLES RESIDENTIAL CARE LLC - JOHNSON HOUSE NPI 1588780761

NPI Information

NPI: 1588780761
Provider Name: MRACLES RESIDENTIAL CARE LLC - JOHNSON HOUSE
Classification: Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities - 320900000X
Entity Type: Organization
Address:
1301 E 79TH ST
KANSAS CITY, MO
ZIP 64131
Phone: (816) 521-8896
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MRACLES RESIDENTIAL CARE LLC - JOHNSON HOUSE is a community based residential treatment facility, intellectual and/or developmental disabilities in Kansas City, MO. The provider is a home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities. MRACLES RESIDENTIAL CARE LLC - JOHNSON HOUSE NPI is 1588780761. The provider is registered as an organization entity type.

The provider's business location address is:

1301 E 79TH ST
KANSAS CITY, MO
ZIP 64131-954
Phone: (816) 521-8896
Fax: (816) 437-7027

The provider's authorized official is Dedree Renee Carlisle .
The authorized official title is Administrator and has the following contact phone number (816) 521-8896.

The enumeration date for this NPI number is 3/21/2007 and was last updated on 10/16/2013.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	320900000X	Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities				Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	856158019	MEDICAID	MISSOURI

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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