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General NPI Number Information
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NPI Number | 1417077082
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Entity Type | Organization
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Legal Business Name | BIG LAKES DEVELOPMENTAL CENTER INC
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Dates
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Enumeration Date | 03/29/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1416 HAYES DR
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City | MANHATTAN
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State | KS
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Zip | 66502-5066
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Country | US
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Telephone | 785-776-9201
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Fax | 785-776-9830
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Provider Business Mailing Address
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Address Line | 1416 HAYES DR
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City | MANHATTAN
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State | KS
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Zip | 66502-5066
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Country | US
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Telephone | 785-776-9201
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Fax | 785-776-9830
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Authorized Official
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Title or Position | VP FOR ADMIN & FINANCE
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Name | PHILLIP KORENEK
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Credential |
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Telephone | 785-776-9201
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State | KS
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