Healthcare Provider Details

I. General information

NPI: 1356773055
Provider Name (Legal Business Name): JOHNSON COUNTY DEVELOPMENTAL SUPPORTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2013
Last Update Date: 08/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10501 LACKMAN RD
LENEXA KS
66219-1223
US

IV. Provider business mailing address

10501 LACKMAN RD
LENEXA KS
66219-1223
US

V. Phone/Fax

Practice location:
  • Phone: 913-826-2626
  • Fax: 913-826-2627
Mailing address:
  • Phone: 913-826-2626
  • Fax: 913-826-2627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. CHAD VONAHNEM
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 913-826-2631