Healthcare Provider Details

I. General information

NPI: 1811964885
Provider Name (Legal Business Name): MULTI COMMUNITY DIVERSIFIED SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 08/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2107 INDUSTRIAL DR
MCPHERSON KS
67460-8128
US

IV. Provider business mailing address

2107 INDUSTRIAL DR
MCPHERSON KS
67460-8128
US

V. Phone/Fax

Practice location:
  • Phone: 620-241-6693
  • Fax: 620-241-6699
Mailing address:
  • Phone: 620-241-6693
  • Fax: 620-241-6699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
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 Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: MR. DOUG WISBY
Title or Position: CEO
Credential:
Phone: 620-241-6693