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General NPI Number Information
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NPI Number | 1639218852
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Entity Type | Organization
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Legal Business Name | SUBSTANCE ABUSE CENTER OF EAST KANSAS
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Dates
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Enumeration Date | 02/05/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3505 RAINBOW BLVD
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City | KANSAS CITY
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State | KS
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Zip | 66103-2078
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Country | US
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Telephone | 913-362-0045
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Fax | 913-362-1533
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Provider Business Mailing Address
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Address Line | 3505 RAINBOW BLVD
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City | KANSAS CITY
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State | KS
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Zip | 66103-2078
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Country | US
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Telephone | 913-362-0045
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Fax | 913-362-1533
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. ERMA CUNNINGHAM EMBRY
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Credential | MSW
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Telephone | 913-362-0045
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 110
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License Number State | KS
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