Provider Demographics
NPI:1083732317
Name:SHAWNEE REGIONAL PREVENTION AND RECOVERY SERVICES
Entity Type:Organization
Organization Name:SHAWNEE REGIONAL PREVENTION AND RECOVERY SERVICES
Other - Org Name:PREVENTION AND RECOVERY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:CALBECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-266-8666
Mailing Address - Street 1:2209 SW 29TH ST
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66611-1908
Mailing Address - Country:US
Mailing Address - Phone:785-266-8666
Mailing Address - Fax:785-266-3833
Practice Address - Street 1:2209 SW 29TH ST
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66611-1908
Practice Address - Country:US
Practice Address - Phone:785-266-8666
Practice Address - Fax:785-266-3833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01450121101YA0400X
KS324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilityGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS014932Medicare UPIN