NPIMap

Organization Active NPI

Jackson Style Adult Day Care

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Grandview, MO
National Provider Identifier
1871779280
Registry record updated Jan 15, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X
License
734 Issued in MO
Legal business name
JACKSON STYLE ADULT DAY CARE
Practice address
12707 2ND St
Grandview, MO 64030-2207
Phone
(816) 763-1078
Fax
(816) 765-9987
NPI assigned
Jan 15, 2008
Organization subpart
Yes
Parent organization
JACKSON STYLE LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 15, 2008

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

Authorized official

Name
Mr. Cleotha Jackson
Title
Administrative Assistant
Phone
(816) 769-8565

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X 734 MO Primary

Addresses

Primary practice location

12707 2ND St
Grandview, MO 64030-2207

Mailing address

12707 2ND St
Grandview, MO 64030-2207
Phone (816) 763-1078

National Provider Directory

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

Other organizations with this tax ID 3

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

NPI Registry JSON

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

{
    "created_epoch": "1200355200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1200355200000",
    "number": "1871779280",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12707 2ND ST",
            "city": "GRANDVIEW",
            "state": "MO",
            "postal_code": "640302207",
            "telephone_number": "816-763-1078",
            "fax_number": "816-765-9987"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12707 2ND ST",
            "city": "GRANDVIEW",
            "state": "MO",
            "postal_code": "640302207",
            "telephone_number": "816-763-1078",
            "fax_number": "816-765-9987"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON STYLE ADULT DAY CARE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "JACKSON STYLE LLC",
        "enumeration_date": "2008-01-15",
        "last_updated": "2008-01-15",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "CLEOTHA",
        "authorized_official_title_or_position": "ADMINISTRATIVE ASSISTANT",
        "authorized_official_telephone_number": "816-769-8565",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "MO",
            "license": "734",
            "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 Jan 15, 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.