NPIMap

Organization Active NPI

Jackson Style Agency, LLC

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Grandview, MO
National Provider Identifier
1386701613
Registry record updated Jul 10, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X
Legal business name
JACKSON STYLE AGENCY, LLC
Practice address
213 Blue Ridge Ext
Grandview, MO 64030-1603
Phone
(816) 765-9990
Fax
(816) 765-9987
NPI assigned
Jan 3, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2007

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

Authorized official

Name
Mr. Cleotha Jackson
Title
Assistant Administrator
Phone
(816) 765-9990

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility 320900000X Primary

Addresses

Primary practice location

213 Blue Ridge Ext
Grandview, MO 64030-1603

Mailing address

213 Blue Ridge Ext
Grandview, MO 64030-1603
Phone (816) 765-9990

National Provider Directory

National Provider Directory
Tax ID family
Kidz Connection Group Home4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Locations

213 Blue Ridge Ext
Grandview, MO 64030
Phone (816) 765-9990

NPI Registry JSON

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

{
    "created_epoch": "1167782400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1184025600000",
    "number": "1386701613",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "213 BLUE RIDGE EXT",
            "city": "GRANDVIEW",
            "state": "MO",
            "postal_code": "640301603",
            "telephone_number": "816-765-9990",
            "fax_number": "816-765-9987"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "213 BLUE RIDGE EXT",
            "city": "GRANDVIEW",
            "state": "MO",
            "postal_code": "640301603",
            "telephone_number": "816-765-9990",
            "fax_number": "816-765-9987"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON STYLE AGENCY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-03",
        "last_updated": "2007-07-10",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "CLEOTHA",
        "authorized_official_title_or_position": "ASSISTANT ADMINISTRATOR",
        "authorized_official_telephone_number": "816-765-9990",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grandview, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2007; 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.