Healthcare Provider Details

I. General information

NPI: 1316659485
Provider Name (Legal Business Name): GREAT PLAINS SUPPORT SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2022
Last Update Date: 02/28/2023
Certification Date: 02/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 N MAIN ST
NORTH NEWTON KS
67117-9002
US

IV. Provider business mailing address

322 S LAURA AVE
WICHITA KS
67211-1517
US

V. Phone/Fax

Practice location:
  • Phone: 316-461-9086
  • Fax: 316-453-4173
Mailing address:
  • Phone: 316-461-9086
  • Fax: 316-453-4173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: STACY R MAGEE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 316-461-9086