| At Provider Group Of Kansas Pa | |
|
9393 W 110th St Ste 500 Overland Park KS 66210-1464 | |
| (845) 769-8758 | |
| Not Available |
| Full Name | At Provider Group Of Kansas Pa |
|---|---|
| Speciality | Clinic/center - Rehabilitation, Substance Use Disorder |
| Location | 9393 W 110th St Ste 500, Overland Park, Kansas |
| Authorized Official Name and Position | Karla Renee Mullings (DIRECTOR OF COMPLIANCE) |
| Authorized Official Contact | 8347698758 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| At Provider Group Of Kansas Pa 1640 Boro Pl Fl 4 Mc Lean VA 22102-3627 Ph: (845) 769-8758 | At Provider Group Of Kansas Pa 9393 W 110th St Ste 500 Overland Park KS 66210-1464 Ph: (845) 769-8758 |
| NPI Number | 1912777046 |
|---|---|
| Provider Enumeration Date | 01/09/2024 |
| Last Update Date | 01/09/2024 |
| Certification Date | 01/09/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912777046 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Secondary |
| 261QR0405X | Clinic/center - Rehabilitation, Substance Use Disorder | (* (Not Available)) | Primary |
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