Healthcare Provider Details

I. General information

NPI: 1265685648
Provider Name (Legal Business Name): SHELTERED LIVING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2008
Last Update Date: 03/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 SW HARRISON ST
TOPEKA KS
66611-2277
US

IV. Provider business mailing address

3401 SW HARRISON ST
TOPEKA KS
66611-2277
US

V. Phone/Fax

Practice location:
  • Phone: 785-233-2566
  • Fax: 785-266-8709
Mailing address:
  • Phone: 785-233-2566
  • Fax: 785-266-8709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: LISA JACKSON
Title or Position: PRESIDENT/CEO
Credential:
Phone: 785-233-2566