Organization
SULLIVAN GANG CARE CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GREGORY D. SULLIVAN (OWNER)
(316) 516-6242
Entity
Organization
Contact information
Practice address
6719 W. DOUGLAS CIRCLE, WICHITA, KS 67209
(316) 838-4862
(316) 262-2970
Mailing address
6404 E. PEPPERWOOD CT., WICHITA, KS 67226
(316) 838-4862
(316) 262-2970
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
100417670A
KS
3747P1801X
Personal Care Attendant
100417670A
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100417670A
—
KS
Enumeration date
05/20/2007
Last updated
06/02/2016
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