Provider Demographics
NPI:1366506446
Name:OUR HOUSE OF KC, INC
Entity type:Organization
Organization Name:OUR HOUSE OF KC, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE ASSISTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:HALISA
Authorized Official - Middle Name:E
Authorized Official - Last Name:BRADSHAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-737-8628
Mailing Address - Street 1:9406 E 63RD ST
Mailing Address - Street 2:B
Mailing Address - City:RAYTOWN
Mailing Address - State:MO
Mailing Address - Zip Code:64133-4904
Mailing Address - Country:US
Mailing Address - Phone:816-737-8628
Mailing Address - Fax:816-737-1064
Practice Address - Street 1:9406 E 63RD ST
Practice Address - Street 2:B
Practice Address - City:RAYTOWN
Practice Address - State:MO
Practice Address - Zip Code:64133-4904
Practice Address - Country:US
Practice Address - Phone:816-737-8628
Practice Address - Fax:816-737-1064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO17809068251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services