Provider Demographics
NPI:1689852238
Name:PLATTE COUNTY BOARD OF SERVICES FOR THE DEVELOPMENTALLY DISABLED
Entity type:Organization
Organization Name:PLATTE COUNTY BOARD OF SERVICES FOR THE DEVELOPMENTALLY DISABLED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:
Authorized Official - Last Name:TILMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-891-0990
Mailing Address - Street 1:7900 NW 106TH ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64153-2372
Mailing Address - Country:US
Mailing Address - Phone:816-891-0990
Mailing Address - Fax:816-891-0937
Practice Address - Street 1:4809 NW 67TH ST
Practice Address - Street 2:CANTERBURY HOUSE
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64151-1925
Practice Address - Country:US
Practice Address - Phone:816-891-0990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-06
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities