DST Inc

Primary specialty

Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X

License

035519 Issued in MO

Legal business name

DST INC

Doing business as

Superior Park

Practice address

410 Superior
Excelsior Springs, MO 64024

Phone

(816) 630-3177

Fax

(816) 630-6100

NPI assigned

Oct 1, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Thomas A Walker

Title

President DST Inc & Administrator

Phone

(816) 630-3177

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Superior Park Doing business as

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

{
    "created_epoch": "1191196800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214784000000",
    "number": "1295922458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 126",
            "address_2": "410 SUPERIOR",
            "city": "EXCELSIOR SPRINGS",
            "state": "MO",
            "postal_code": "64024",
            "telephone_number": "816-630-3177",
            "fax_number": "816-630-6100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "410 SUPERIOR",
            "city": "EXCELSIOR SPRINGS",
            "state": "MO",
            "postal_code": "64024",
            "telephone_number": "816-630-3177",
            "fax_number": "816-630-6100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DST INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-01",
        "last_updated": "2008-06-30",
        "status": "A",
        "authorized_official_last_name": "WALKER",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT DST INC & ADMINISTRATOR",
        "authorized_official_telephone_number": "816-630-3177",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "3104A0625X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Mental Illness",
            "state": "MO",
            "license": "033231",
            "primary": false
        },
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "MO",
            "license": "035519",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "268002409",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Superior Park",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Mental Illness Community Based Residential Treatment Facility in Excelsior Springs, MO
• Providers in Excelsior Springs, MO by specialty
• Mental Illness Community Based Residential Treatment Facility in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2008; 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.