Provider Demographics
NPI:1285065474
Name:LIGHT HOUSE OF HOPE CORPORATION OF KANSAS CITY
Entity type:Organization
Organization Name:LIGHT HOUSE OF HOPE CORPORATION OF KANSAS CITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:COYLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-206-6698
Mailing Address - Street 1:7914 LEAVENWORTH RD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66109-1578
Mailing Address - Country:US
Mailing Address - Phone:913-206-6698
Mailing Address - Fax:913-788-9040
Practice Address - Street 1:7914 LEAVENWORTH RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66109-1578
Practice Address - Country:US
Practice Address - Phone:913-206-6698
Practice Address - Fax:913-788-9040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-12
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No251C00000XAgenciesDay Training, Developmentally Disabled Services