Healthcare Provider Details

I. General information

NPI: 1053380782
Provider Name (Legal Business Name): ARROWHEAD WEST, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 E WYATT EARP BLVD
DODGE CITY KS
67801-5337
US

IV. Provider business mailing address

1100 E WYATT EARP BLVD
DODGE CITY KS
67801-5337
US

V. Phone/Fax

Practice location:
  • Phone: 620-227-8803
  • Fax: 620-227-8812
Mailing address:
  • Phone: 620-227-8803
  • Fax: 620-227-8812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171WV0202X
TaxonomyVehicle Modifications Contractor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: MS. LORI PENDERGAST
Title or Position: PRESIDENT
Credential:
Phone: 620-227-8803