Organization
KISA LIFE RECOVERY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY JONES (OWNER)
(620) 710-5058
Entity
Organization
Contact information
Practice address
865 STATE HIGHWAY 99, SEDAN, KS 67361-8501
(620) 710-5058
Mailing address
865 STATE HIGHWAY 99, SEDAN, KS 67361-8501
(620) 710-5058
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
00460061
KS
Other
Enumeration date
10/04/2017
Last updated
06/20/2018
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