Organization
SAMANTHA COLLINS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SAMANTHA COLLINS (OWNER)
(785) 289-7789
Entity
Organization
Contact information
Practice address
710 SW FAIRLAWN RD APT 301A, TOPEKA, KS 66606-2374
(785) 289-7789
Mailing address
710 SW FAIRLAWN RD APT 301A, TOPEKA, KS 66606-2374
(785) 289-7789
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0000
—
KS
Enumeration date
08/28/2015
Last updated
08/28/2015
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