Organization
CENTER FOR INDEPENDENT LIVING SOUTHWEST KANSAS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TROY ALAN HORTON (EXECUTIVE DIRECTOR)
(620) 276-1900
Entity
Organization
Contact information
Practice address
1802 E SPRUCE ST, GARDEN CITY, KS 67846-6337
(620) 276-1900
(620) 271-0200
Mailing address
1802 E SPRUCE ST, PO BOX 2090, GARDEN CITY, KS 67846-6337
(620) 276-1900
(620) 271-0200
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100318180A
—
KS
05
—
100318180B
—
KS
05
—
100318180C
—
KS
05
—
100318180D
—
KS
Enumeration date
03/15/2007
Last updated
09/30/2008
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