NPIMap

Organization Active NPI

Betty Lou Wallace Recovery LLC

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Kansas City, MO
National Provider Identifier
1104417419
Registry record updated Jan 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
Legal business name
BETTY LOU WALLACE RECOVERY LLC
Practice address
13645 Holmes Rd
Kansas City, MO 64145-1482
Phone
(480) 388-1495
NPI assigned
Jan 29, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 29, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Geffen Liberman
Title
Executive Director
Phone
(480) 388-1495

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X Primary

Addresses

Primary practice location

13645 Holmes Rd
Kansas City, MO 64145-1482

Mailing address

13340 Holmes Rd
Kansas City, MO 64145-1437
Phone (816) 786-7074

National Provider Directory

National Provider Directory
Tax ID family
Betty Lou Wallace Recovery LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

13645 Holmes Rd
Kansas City, MO 64145
Phone (480) 388-1495

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1611878400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1611878400000",
    "number": "1104417419",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13340 HOLMES RD",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641451437",
            "telephone_number": "816-786-7074"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13645 HOLMES RD",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641451482",
            "telephone_number": "480-388-1495"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BETTY LOU WALLACE RECOVERY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-29",
        "last_updated": "2021-01-29",
        "certification_date": "2021-01-29",
        "status": "A",
        "authorized_official_last_name": "LIBERMAN",
        "authorized_official_first_name": "GEFFEN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "480-388-1495"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kansas City, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.