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General NPI Number Information
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NPI Number | 1336479682
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Entity Type | Organization
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Legal Business Name | ROSWELL ADDICTION TREATMENT
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Dates
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Enumeration Date | 01/09/2010
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Last Update Date | 01/09/2010
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Provider Practice Location Address
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Address Line | 1401 N 18TH ST
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City | KANSAS CITY
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State | KS
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Zip | 66102-2845
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Country | US
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Telephone | 913-387-4773
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Fax | 913-621-2297
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Provider Business Mailing Address
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Address Line | 1401 N 18TH ST
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City | KANSAS CITY
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State | KS
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Zip | 66102-2845
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Country | US
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Telephone | 913-387-4773
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Fax | 913-621-2297
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DR. JAMES O. MAXWELL
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Credential | D.MIN
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Telephone | 913-957-3596
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0800X
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Taxonomy Name | Recovery Care Clinic/Center
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License Number | 07070894
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License Number State | KS
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