Alyce D. Clark

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

License

856274402 Issued in MO

Legal business name

ALYCE D. CLARK

Doing business as

Shepherd's Lane

Practice address

10640 Holmes Road
Kansas City, MO 64131-3404

Phone

(816) 943-1300

Fax

(816) 942-7443

NPI assigned

Mar 27, 2007

Last updated

Jul 29, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Alyce Denise Clark, RN, BSN

Title

Owner

Phone

(816) 943-1300

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Shepherd's Lane Doing business as

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

{
    "created_epoch": "1174953600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1217289600000",
    "number": "1649398769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10640 HOLMES RD",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641313404",
            "telephone_number": "816-943-1300",
            "fax_number": "816-942-7443"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10640 HOLMES ROAD",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641313404",
            "telephone_number": "816-943-1300",
            "fax_number": "816-942-7443"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALYCE D. CLARK",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-27",
        "last_updated": "2008-07-29",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "ALYCE",
        "authorized_official_middle_name": "DENISE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "816-943-1300",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RN, BSN"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "MO",
            "license": "856274402",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DMH VENDOR NUMBER",
            "identifier": "8002103",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "856274402",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shepherd's Lane",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Kansas City, MO
• Providers in Kansas City, MO by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 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.