Healthcare Provider Details

I. General information

NPI: 1841627734
Provider Name (Legal Business Name): REFLECTION OF PEACE HOME CARE AND ASSISTED LIVING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2013
Last Update Date: 07/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19988 W 162ND ST
OLATHE KS
66062
US

IV. Provider business mailing address

19933 W 162ND ST
OLATHE KS
66062-2787
US

V. Phone/Fax

Practice location:
  • Phone: 913-839-9068
  • Fax: 913-815-3463
Mailing address:
  • Phone: 913-223-9670
  • Fax: 913-257-5879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number StateKS

VIII. Authorized Official

Name: SHEENA NICOLE MANN
Title or Position: DIRECTOR
Credential:
Phone: 913-223-9670