Healthcare Provider Details

I. General information

NPI: 1386611226
Provider Name (Legal Business Name): KINGS CAMP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24401 W MACARTHUR RD
GODDARD KS
67052-8713
US

IV. Provider business mailing address

PO BOX 215
GODDARD KS
67052-0215
US

V. Phone/Fax

Practice location:
  • Phone: 316-794-2913
  • Fax: 319-794-2773
Mailing address:
  • Phone: 316-794-2913
  • Fax: 316-794-2773

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number36366002
License Number StateKS

VIII. Authorized Official

Name: MS. DOROTHY M PAASCH
Title or Position: OFFICE MANAGER
Credential:
Phone: 316-794-2913