Healthcare Provider Details

I. General information

NPI: 1164831418
Provider Name (Legal Business Name): SUNFLOWER WELLNESS RETREAT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2014
Last Update Date: 08/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29875 W 339TH ST
OSAWATOMIE KS
66064-4159
US

IV. Provider business mailing address

29875 W 339TH ST
OSAWATOMIE KS
66064-4159
US

V. Phone/Fax

Practice location:
  • Phone: 913-481-9389
  • Fax:
Mailing address:
  • Phone: 913-481-9389
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number001Y003D
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code276400000X
TaxonomySubstance Use Disorder Rehabilitation Hospital Unit
License Number001Y003D
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License Number001Y003D
License Number StateKS
# 4
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number001Y003D
License Number StateKS

VIII. Authorized Official

Name: MR. JOSEPH WILLIAM HAMMER
Title or Position: DIRECTOR
Credential:
Phone: 913-481-9389