Healthcare Provider Details

I. General information

NPI: 1164564340
Provider Name (Legal Business Name): COMMUNITY LIVING OPPORTUNITIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11627 W 79TH ST
LENEXA KS
66214-1488
US

IV. Provider business mailing address

PO BOX 14395
LENEXA KS
66285-4395
US

V. Phone/Fax

Practice location:
  • Phone: 913-341-9316
  • Fax: 913-341-1198
Mailing address:
  • Phone: 913-341-9316
  • Fax: 913-341-1198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310500000X
TaxonomyMental Illness Intermediate Care Facility
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN FLOYD
Title or Position: FINANCIAL ANALYST
Credential:
Phone: 913-341-9316