| NPI | 1932275526 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK CONOVER COO 660-665-1962 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: KS 629) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: KS 541 574 613 629) |
| 324500000X Substance Abuse Rehabilitation Facility (Licence: KS 541 574 613) | |
| 3245S0500X Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children (Licence: KS 541 649) | |
| Enumeration Date | 2006-11-27 |
| Last Update Date | 2020-07-29 |