Organization · Type 2 NPI

State of Missouri

Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility · Kansas City, MO

NPI number 1922207679 Active

Practice location

5410 Rinker Rd
Kansas City, MO 64129-2308

Call (816) 512-7515 Map

Fax (816) 512-7517

Mailing address

1706 E Elm St
Jefferson City, MO 65101-4130

Specialties and licenses

Taxonomy	Code	License
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility Primary	320900000X	None listed

Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility: A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with intellectual and/or developmental disabilities.

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NPI record

NPI: 1922207679
Entity type: Organization (Type 2)
Issued: Jul 13, 2007
Last updated: Oct 27, 2020
Status: Active
Subpart: Yes of State of Missouri

Other names

<unavail>
Esperanza Group Home · doing business as
Esperanza Group Home · doing business as

Authorized official

Molly Jane Boeckmann
Director of Administrative Services
(573) 751-4055

Verify this record

This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1922207679

State of Missouri's National Provider Identifier is 1922207679, issued on Jul 13, 2007. The primary taxonomy on file is Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility (320900000X), and the practice location is in Kansas City, MO. The record was last updated on Oct 27, 2020.