Provider Demographics
NPI:1114065489
Name:SUBSTANCE ABUSE ASSESSMENT CTR
Entity Type:Organization
Organization Name:SUBSTANCE ABUSE ASSESSMENT CTR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:
Authorized Official - Last Name:CASEY
Authorized Official - Suffix:
Authorized Official - Credentials:BA-LAC
Authorized Official - Phone:316-267-3825
Mailing Address - Street 1:731 N WATER ST
Mailing Address - Street 2:STE 4
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67203-3853
Mailing Address - Country:US
Mailing Address - Phone:316-267-3825
Mailing Address - Fax:316-267-3843
Practice Address - Street 1:731 N WATER ST
Practice Address - Street 2:STE 2
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-3853
Practice Address - Country:US
Practice Address - Phone:316-267-3825
Practice Address - Fax:316-267-3843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100320580AMedicaid