MEDICARE: SEED CENTER ROSWELL REHABILITATION ADDICTION PROGRAM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0800X	Recovery Care Clinic/Center	07070894	KS

General Provider Information

NPI Number	:	1194043968
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SEED CENTER ROSWELL REHABILITATION ADDICTION PROGRAM

Provider Business Mailing Address
First Line	:	1659 WASHINGTON BLVD
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66102-2841
Country	:	US
Telephone Number	:	913-233-2223
Fax Number	:

Provider Business Practice Location Address
First Line	:	1659 WASHINGTON BLVD
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66102-2841
Country	:	US
Telephone Number	:	913-233-2223
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL DIRECTOR
Name	:	MR. ALAN D PORTER
Credential	:	MSW
Telephone Number	:	573-823-0283

Provider Enumeration Date	:	05/04/2010
Last Update Date	:	05/04/2010

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