Healthcare Provider Details

I. General information

NPI: 1710095435
Provider Name (Legal Business Name): IROQUOIS CENTER FOR HUMAN DEVELOPMENT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 E GRANT AVE
GREENSBURG KS
67054-2708
US

IV. Provider business mailing address

610 E GRANT AVE
GREENSBURG KS
67054-2708
US

V. Phone/Fax

Practice location:
  • Phone: 620-723-2272
  • Fax: 620-723-2272
Mailing address:
  • Phone: 620-723-2272
  • Fax: 620-723-2272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CHARLES SHELDON CARPENTER
Title or Position: EXECUTIVE DIRECTOR
Credential: LMLP, LCP
Phone: 620-723-2272