=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477521151
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DEVELOPMENTAL SERVICES OF NORTHWEST KANSAS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/09/2006
-----------------------------------------------------
Last Update Date | 03/17/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2703 HALL ST SUITE 10
-----------------------------------------------------
City | HAYS
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67601-1964
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 785-625-5678
-----------------------------------------------------
Fax | 785-625-8204
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 310
-----------------------------------------------------
City | HAYS
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67601-0310
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 785-625-5678
-----------------------------------------------------
Fax | 785-625-8204
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. GERARD L. MICHAUD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 785-625-5678
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 252Y00000X
-----------------------------------------------------
Taxonomy Name | Early Intervention Provider Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------