Provider Demographics
NPI:1053467811
Name:TIYOSPAYE, INC
Entity Type:Organization
Organization Name:TIYOSPAYE, INC
Other - Org Name:HIGHER GROUND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:SAN MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-262-2060
Mailing Address - Street 1:247 N MARKET ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67202-2003
Mailing Address - Country:US
Mailing Address - Phone:316-262-2060
Mailing Address - Fax:316-262-2740
Practice Address - Street 1:247 N MARKET ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67202-2003
Practice Address - Country:US
Practice Address - Phone:316-262-2060
Practice Address - Fax:316-262-2740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS412251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100371160AMedicaid