Healthcare Provider Details

I. General information

NPI: 1275683260
Provider Name (Legal Business Name): SOUTHEAST KANSAS INDEPENDENT LIVING RESOURCE CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 01/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 MAIN ST
PARSONS KS
67357-3367
US

IV. Provider business mailing address

PO BOX 957
PARSONS KS
67357-0957
US

V. Phone/Fax

Practice location:
  • Phone: 620-421-5502
  • Fax: 620-421-3705
Mailing address:
  • Phone: 620-421-5502
  • Fax: 620-421-3705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: SHARI J COATNEY
Title or Position: DIRECTOR CEO
Credential:
Phone: 620-421-5502