Provider Demographics
NPI:1104042290
Name:KELLEY DETENTION SERVICES OF WAKEENEY, INC.
Entity Type:Organization
Organization Name:KELLEY DETENTION SERVICES OF WAKEENEY, INC.
Other - Org Name:TREGO COUNTY SECURE CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE-PRESIDENT - COO
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-232-7445
Mailing Address - Street 1:7945 FLINT ST
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66214-3333
Mailing Address - Country:US
Mailing Address - Phone:913-647-7732
Mailing Address - Fax:913-647-7710
Practice Address - Street 1:675 SOUTH 13TH STREET
Practice Address - Street 2:
Practice Address - City:WAKEENEY
Practice Address - State:KS
Practice Address - Zip Code:67672
Practice Address - Country:US
Practice Address - Phone:785-743-5378
Practice Address - Fax:785-743-5245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0033863-001322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children