Organization
EXCLUSIVE LIVING RESOURCES INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KIRK RICHARD BAIN (EXCUTIVE DIRECTOR)
(620) 363-1337
Entity
Organization
Contact information
Practice address
512 S KENTUCKY ST, IOLA, KS 66749-3910
(620) 363-1337
Mailing address
512 S KENTUCKY ST, IOLA, KS 66749-3910
(620) 363-1337
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
200877210A
KS
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
200877210A
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200877210A
—
KS
Enumeration date
09/11/2013
Last updated
09/11/2013
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