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11806 W 77th St Lenexa KS 66214-1456 | |
| (913) 322-7212 | |
| (913) 322-7250 |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 11806 W 77th St, Lenexa, Kansas |
| Authorized Official Name and Position | Tara Katalinic (COMPLIANCE ANALYST) |
| Authorized Official Contact | 4802953328 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
11806 W 77th St Lenexa KS 66214-1456 Ph: (913) 322-7212 | 11806 W 77th St Lenexa KS 66214-1456 Ph: (913) 322-7212 |
| NPI Number | 1326288556 |
|---|---|
| Provider Enumeration Date | 02/27/2009 |
| Last Update Date | 02/05/2025 |
| Certification Date | 02/05/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326288556 | NPI | - | NPPES |
| 200564080A | Medicaid | KS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| 253Z00000X | In Home Supportive Care | (* (Not Available)) | Secondary |
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