Healthcare Provider Details

I. General information

NPI: 1083732317
Provider Name (Legal Business Name): SHAWNEE REGIONAL PREVENTION AND RECOVERY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 04/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2209 SW 29TH ST
TOPEKA KS
66611-1908
US

IV. Provider business mailing address

2209 SW 29TH ST
TOPEKA KS
66611-1908
US

V. Phone/Fax

Practice location:
  • Phone: 785-266-8666
  • Fax: 785-266-3833
Mailing address:
  • Phone: 785-266-8666
  • Fax: 785-266-3833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number01450121
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number StateKS

VIII. Authorized Official

Name: MR. JOHN CALBECK
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 785-266-8666