| NPI | 1518012673 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENT WIDICK Superintendent 785-296-5301 |
| Organization Subpart ? | No |
| Primary Taxonomy | 315P00000X Intermediate Care Facility, Intellectual Disabilities |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: KS 1353996081) |
| Enumeration Date | 2007-01-25 |
| Last Update Date | 2019-01-22 |