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General NPI Number Information
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NPI Number | 1114051976
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Entity Type | Organization
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Legal Business Name | NORTHEAST KANSAS COMMUNITY ACTION PROGRAM
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Dates
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Enumeration Date | 03/15/2007
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Last Update Date | 06/18/2008
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Provider Practice Location Address
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Address Line | 1260 220TH STREET
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City | HIAWATHA
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State | KS
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Zip | 66434-0380
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Country | US
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Telephone | 785-742-2222
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Fax | 785-742-2164
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Provider Business Mailing Address
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Address Line | PO BOX 380
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City | HIAWATHA
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State | KS
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Zip | 66434-0380
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Country | US
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Telephone | 785-742-2222
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Fax | 785-742-2164
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. LU HANGLEY
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Credential |
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Telephone | 785-742-2222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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