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330 Poyntz Ave Ste 272 Manhattan KS 66502-8039 | |
| (505) 379-1270 | |
| (888) 972-1885 |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 330 Poyntz Ave Ste 272, Manhattan, Kansas |
| Authorized Official Name and Position | Lacey Stewart (OWNER) |
| Authorized Official Contact | 5054407169 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 1126 Manhattan KS 66505-1126 Ph: (505) 440-7169 | 330 Poyntz Ave Ste 272 Manhattan KS 66502-8039 Ph: (505) 379-1270 |
| NPI Number | 1710398821 |
|---|---|
| Provider Enumeration Date | 05/12/2014 |
| Last Update Date | 10/17/2022 |
| Certification Date | 10/17/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710398821 | NPI | - | NPPES |
| 47225335 | Medicaid | NM | |
| 201329460A | Medicaid | KS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 0187211 (New Mexico) | Primary |
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Secondary |
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