Organization
SHADY COTTAGE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SAMANTHA JANE CLARK (OWNER)
(785) 527-2729
Entity
Organization
Contact information
Practice address
1411 17TH ST, BELLEVILLE, KS 66935-3028
(785) 527-2650
Mailing address
1302 K ST, BELLEVILLE, KS 66935-1801
(785) 527-2729
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
200688530B
KMAP ID NUMBER
KS
Enumeration date
09/16/2013
Last updated
11/04/2019
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