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General NPI Number Information
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NPI Number | 1225246317
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Entity Type | Organization
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Legal Business Name | SULLIVAN GANG CARE CENTER
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Dates
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Enumeration Date | 05/20/2007
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Last Update Date | 06/02/2016
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Provider Practice Location Address
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Address Line | 6719 W. DOUGLAS CIRCLE
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City | WICHITA
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State | KS
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Zip | 67209
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Country | US
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Telephone | 316-838-4862
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Fax | 316-262-2970
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Provider Business Mailing Address
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Address Line | 6404 E. PEPPERWOOD CT.
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City | WICHITA
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State | KS
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Zip | 67226
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Country | US
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Telephone | 316-838-4862
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Fax | 316-262-2970
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Authorized Official
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Title or Position | OWNER
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Name | MR. GREGORY D. SULLIVAN
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Credential |
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Telephone | 316-516-6242
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number | 100417670A
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number | 100417670A
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License Number State | KS
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