Provider Demographics
NPI:1184628646
Name:KINGS CAMP INC
Entity Type:Organization
Organization Name:KINGS CAMP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:MAY
Authorized Official - Last Name:PAASCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-794-2913
Mailing Address - Street 1:PO BOX 215
Mailing Address - Street 2:
Mailing Address - City:GODDARD
Mailing Address - State:KS
Mailing Address - Zip Code:67052-0215
Mailing Address - Country:US
Mailing Address - Phone:316-794-2913
Mailing Address - Fax:316-794-2773
Practice Address - Street 1:24401 W MACARTHUR RD
Practice Address - Street 2:
Practice Address - City:GODDARD
Practice Address - State:KS
Practice Address - Zip Code:67052-8713
Practice Address - Country:US
Practice Address - Phone:316-794-2913
Practice Address - Fax:316-794-2773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS251B00000X320600000X
KS2084P0800X320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS103575OtherBLUE CROSS & BLUE SHIELD