Healthcare Provider Details

I. General information

NPI: 1215346077
Provider Name (Legal Business Name): ATCHISON CITY INFANT-TODDLER PROGRAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2014
Last Update Date: 08/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

626 COMMERCIAL ST
ATCHISON KS
66002-2405
US

IV. Provider business mailing address

947 W 47 HWY
GIRARD KS
66743-2347
US

V. Phone/Fax

Practice location:
  • Phone: 620-724-6281
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: SHERRY DOMANN
Title or Position: DIRECTOR
Credential:
Phone: 913-360-5523