| NPI | 1588105092 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEREK DEWAYNE VANN President 913-915-1380 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 251C00000X |
| 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| 320700000X Residential Treatment Facility, Physical Disabilities | |
| 320800000X Community Based Residential Treatment Facility, Mental Illness | |
| 347C00000X Private Vehicle | |
| Enumeration Date | 2017-03-16 |
| Last Update Date | 2017-03-16 |