Healthcare Provider Details

I. General information

NPI: 1932275526
Provider Name (Legal Business Name): PREFERRED FAMILY HEALTHCARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2006
Last Update Date: 07/29/2020
Certification Date: 07/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 S HILLSIDE ST
WICHITA KS
67211-3004
US

IV. Provider business mailing address

900 E LAHARPE ST PO BOX 767
KIRKSVILLE MO
63501-4520
US

V. Phone/Fax

Practice location:
  • Phone: 316-613-2222
  • Fax: 316-613-2220
Mailing address:
  • Phone: 660-665-1962
  • Fax: 660-665-3989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number541 574 613 629
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number541 574 613
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number541 649
License Number StateKS
# 4
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number629
License Number StateKS

VIII. Authorized Official

Name: MARK CONOVER
Title or Position: COO
Credential:
Phone: 660-665-1962