=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467557983
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CORNER HOUSE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/13/2006
-----------------------------------------------------
Last Update Date | 05/23/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 418 MARKET STREET
-----------------------------------------------------
City | EMPORIA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 620-342-3015
-----------------------------------------------------
Fax | 620-343-7606
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 931
-----------------------------------------------------
City | EMPORIA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66801-0931
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 620-342-3015
-----------------------------------------------------
Fax | 620-343-7606
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MS. SARAH MARIE RILEY-HANSEN
-----------------------------------------------------
Credential | MS LPC NCC AAPS
-----------------------------------------------------
Telephone | 620-342-3015
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 324500000X
-----------------------------------------------------
Taxonomy Name | Substance Abuse Rehabilitation Facility
-----------------------------------------------------
License Number | 097
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QR0405X
-----------------------------------------------------
Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
-----------------------------------------------------
License Number | 097
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------