Healthcare Provider Details

I. General information

NPI: 1174642458
Provider Name (Legal Business Name): SUNFLOWER DIVERSIFIED SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 05/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8823 FOURTH STREET
GREAT BEND KS
67530-0838
US

IV. Provider business mailing address

PO BOX 838
GREAT BEND KS
67530-0838
US

V. Phone/Fax

Practice location:
  • Phone: 620-792-1321
  • Fax: 620-793-4709
Mailing address:
  • Phone: 162-079-2132
  • Fax: 620-793-4709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateNULL
# 6
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNULL
# 7
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNULL

VIII. Authorized Official

Name: JAMES JOHNSON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 16207921321