Provider Demographics
NPI:1760032262
Name:ST MAGDALENA OF KANSAS CITY
Entity type:Organization
Organization Name:ST MAGDALENA OF KANSAS CITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:980-225-6876
Mailing Address - Street 1:8116 S TRYON ST STE 11
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28273-4300
Mailing Address - Country:US
Mailing Address - Phone:980-225-6876
Mailing Address - Fax:
Practice Address - Street 1:1201 NW BRIARCLIFF PKWY STE 200
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-1772
Practice Address - Country:US
Practice Address - Phone:980-225-6876
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-17
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No251C00000XAgenciesDay Training, Developmentally Disabled Services