Provider Demographics
NPI:1104090653
Name:PILLAR RESIDENTIAL OPPORTUNIITES
Entity type:Organization
Organization Name:PILLAR RESIDENTIAL OPPORTUNIITES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:
Authorized Official - Last Name:PERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-313-8441
Mailing Address - Street 1:1814 N WHITNEY RD
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64058-1574
Mailing Address - Country:US
Mailing Address - Phone:816-313-8441
Mailing Address - Fax:888-431-0585
Practice Address - Street 1:1814 N WHITNEY RD
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64058-1574
Practice Address - Country:US
Practice Address - Phone:816-313-8441
Practice Address - Fax:888-431-0585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-16
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO8001575320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO850033326Medicaid