MEDICARE: GREAT PLAINS SUPPORT SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility
2	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
3	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1316659485
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREAT PLAINS SUPPORT SERVICES LLC

Provider Business Mailing Address
First Line	:	322 S LAURA AVE
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67211-1517
Country	:	US
Telephone Number	:	316-461-9086
Fax Number	:	316-453-4173

Provider Business Practice Location Address
First Line	:	2501 N MAIN ST
Second Line	:
City	:	NORTH NEWTON
State	:	KS
Zip	:	67117-9002
Country	:	US
Telephone Number	:	316-461-9086
Fax Number	:	316-453-4173

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	STACY R MAGEE
Credential	:
Telephone Number	:	316-461-9086

Provider Enumeration Date	:	12/20/2022
Last Update Date	:	02/28/2023

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