Organization
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Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHERYL WHITEMAN (DIRECTOR)
(620) 221-4898
Entity
Organization
Contact information
Practice address
4303 MEADOWBROOK LN, WINFIELD, KS 67156-8823
(620) 221-4898
(620) 221-4393
Mailing address
4303 MEADOWBROOK LN, WINFIELD, KS 67156-8823
(620) 221-4898
(620) 221-4393
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
100389250-A
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100389250-A
—
KS
Enumeration date
12/10/2007
Last updated
12/10/2007
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