Provider Demographics
NPI:1053574103
Name:DISMAS HOUSE OF KANSAS CITY
Entity type:Organization
Organization Name:DISMAS HOUSE OF KANSAS CITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LADELL
Authorized Official - Middle Name:M
Authorized Official - Last Name:FLOWERS
Authorized Official - Suffix:
Authorized Official - Credentials:M ED RSAP QP REV
Authorized Official - Phone:816-531-6050
Mailing Address - Street 1:207 W LINWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-1327
Mailing Address - Country:US
Mailing Address - Phone:816-531-6050
Mailing Address - Fax:
Practice Address - Street 1:207 W LINWOOD BLVD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-1327
Practice Address - Country:US
Practice Address - Phone:816-531-6050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-09
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO616910679251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health