Provider Demographics
NPI:1902167067
Name:SUPPORT PROFESSIONALS II
Entity Type:Organization
Organization Name:SUPPORT PROFESSIONALS II
Other - Org Name:SUPPORT PROFESSIONALS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PATRICE
Authorized Official - Middle Name:
Authorized Official - Last Name:VERAGUTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-898-7529
Mailing Address - Street 1:8540 BLUE RIDGE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64138
Mailing Address - Country:US
Mailing Address - Phone:816-759-0112
Mailing Address - Fax:
Practice Address - Street 1:8540 BLUE RIDGE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64138
Practice Address - Country:US
Practice Address - Phone:816-759-0112
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness