| NPI | 1710172473 |
|---|---|
| Former Legal Business Name | DBA RIVERSIDE ACADEMY, PREVIOUSLY CAMELOT OF KANSAS, LLC |
| Entity Type | Organization |
| Authorized Contact | HEATHER D. SELL Executive Director 316-267-5710 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 323P00000X Psychiatric Residential Treatment Facility (Licence: KS 62020) |
| Additional Taxonomies | 323P00000X Psychiatric Residential Treatment Facility |
| Enumeration Date | 2007-09-06 |
| Last Update Date | 2011-08-30 |