Healthcare Provider Details

I. General information

NPI: 1790940591
Provider Name (Legal Business Name): MARILLAC CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2008
Last Update Date: 07/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8000 W 127TH ST
OVERLAND PARK KS
66213-2714
US

IV. Provider business mailing address

8000 W 127TH ST
OVERLAND PARK KS
66213-2714
US

V. Phone/Fax

Practice location:
  • Phone: 816-508-3300
  • Fax: 816-508-3321
Mailing address:
  • Phone: 816-508-3300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. MARK RICHARDS
Title or Position: PRESIDENT/CEO
Credential:
Phone: 816-508-3318