Organization
PHOENIX DEVELOPMENTAL SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROY T LINGENFELTER (OWNER-DIRECTOR)
(620) 481-7728
Entity
Organization
Contact information
Practice address
1114 EAST ST APT 2, EMPORIA, KS 66801-7103
(620) 481-7728
Mailing address
2400 W VIEW TER, EMPORIA, KS 66801-5951
(620) 481-7728
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
11/28/2022
Last updated
11/28/2022
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