Provider Demographics
NPI:1861537391
Name:CASS COUNTY COMMUNITY LIVING INC.
Entity type:Organization
Organization Name:CASS COUNTY COMMUNITY LIVING INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:YAVONNE
Authorized Official - Last Name:TALCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-380-6322
Mailing Address - Street 1:1909 S JEFFERSON PKWY
Mailing Address - Street 2:
Mailing Address - City:HARRISONVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64701-3712
Mailing Address - Country:US
Mailing Address - Phone:816-380-6322
Mailing Address - Fax:816-380-3308
Practice Address - Street 1:1909 S JEFFERSON PKWY
Practice Address - Street 2:
Practice Address - City:HARRISONVILLE
Practice Address - State:MO
Practice Address - Zip Code:64701-3712
Practice Address - Country:US
Practice Address - Phone:816-380-6322
Practice Address - Fax:816-380-3308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO6825656OtherVENDOR HILLCREST PLACE 2
MO7156251OtherISL 2
MO6825664OtherKNOLLBROOK 2