Healthcare Provider Details

I. General information

NPI: 1730565532
Provider Name (Legal Business Name): UNIVEST, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2015
Last Update Date: 08/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 E 24TH ST
SEDALIA MO
65301-8233
US

IV. Provider business mailing address

1730 NE 54TH ST
TOPEKA KS
66617-2623
US

V. Phone/Fax

Practice location:
  • Phone: 660-827-3313
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number043278
License Number StateMO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: SHAWN WOOLERY
Title or Position: MEMBER
Credential: R.N.
Phone: 785-217-5999