Provider Demographics
NPI:1114072709
Name:TRI-VALLEY DEVELOPMENTAL SERVICES, INC.
Entity Type:Organization
Organization Name:TRI-VALLEY DEVELOPMENTAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:REDDICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-431-7401
Mailing Address - Street 1:3740 S SANTA FE AVE
Mailing Address - Street 2:P.O. BOX 518
Mailing Address - City:CHANUTE
Mailing Address - State:KS
Mailing Address - Zip Code:66720-3247
Mailing Address - Country:US
Mailing Address - Phone:620-431-7401
Mailing Address - Fax:620-431-1409
Practice Address - Street 1:3740 S SANTA FE AVE
Practice Address - Street 2:
Practice Address - City:CHANUTE
Practice Address - State:KS
Practice Address - Zip Code:66720-3247
Practice Address - Country:US
Practice Address - Phone:620-431-7401
Practice Address - Fax:620-431-1409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100041040AMedicaid