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General NPI Number Information
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NPI Number | 1669698759
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Entity Type | Organization
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Legal Business Name | CLARENCE M. KELLEY DETENTION SERVICES, INC.
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Dates
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Enumeration Date | 04/17/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6700 SOUTHWEST TOPEKA BOULEVARD BUILDING 379, FORBES FIELD
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City | TOPEKA
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State | KS
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Zip | 66214
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Country | US
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Telephone | 785-862-5378
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Fax | 785-862-1683
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Provider Business Mailing Address
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Address Line | 7945 FLINT ST
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City | LENEXA
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State | KS
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Zip | 66214-3333
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Country | US
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Telephone | 913-647-7732
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Fax | 913-647-7710
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Authorized Official
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Title or Position | VICE-PRESIDENT - COO
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Name | TERRY L. CAMPBELL
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Credential |
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Telephone | 785-232-7445
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number | 26228-2
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License Number State | KS
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