Provider Demographics
NPI:1588728018
Name:HARRY S. TRUMAN CHILDRENS NEUROLOGICAL CENTER
Entity type:Organization
Organization Name:HARRY S. TRUMAN CHILDRENS NEUROLOGICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:D
Authorized Official - Last Name:LANDRUM
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:816-373-5060
Mailing Address - Street 1:12404 E US HIGHWAY 40
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-5954
Mailing Address - Country:US
Mailing Address - Phone:816-373-5060
Mailing Address - Fax:816-373-5787
Practice Address - Street 1:8316 PERSHING RD
Practice Address - Street 2:
Practice Address - City:RAYTOWN
Practice Address - State:MO
Practice Address - Zip Code:64138-3633
Practice Address - Country:US
Practice Address - Phone:816-737-8178
Practice Address - Fax:816-353-3607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO12606545320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO852522838Medicaid