Provider Demographics
NPI:1114995701
Name:MULTI COMMUNITY DIVERSIFIED SERVICES, INC.
Entity Type:Organization
Organization Name:MULTI COMMUNITY DIVERSIFIED SERVICES, INC.
Other - Org Name:SOUTH MAPLE HOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:COLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKENNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-241-6693
Mailing Address - Street 1:2107 INDUSTRIAL DR
Mailing Address - Street 2:
Mailing Address - City:MCPHERSON
Mailing Address - State:KS
Mailing Address - Zip Code:67460-8128
Mailing Address - Country:US
Mailing Address - Phone:620-241-6693
Mailing Address - Fax:620-241-6699
Practice Address - Street 1:500 S MAPLE ST
Practice Address - Street 2:
Practice Address - City:MCPHERSON
Practice Address - State:KS
Practice Address - Zip Code:67460-5317
Practice Address - Country:US
Practice Address - Phone:620-241-4473
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-09
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSN-059-012315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100108380GMedicaid