Provider Demographics
NPI:1275531295
Name:DEVELOPMENTAL SERVICES OF NORTHWEST KANSAS, INC.
Entity Type:Organization
Organization Name:DEVELOPMENTAL SERVICES OF NORTHWEST KANSAS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GERARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:MICHAUD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-625-5678
Mailing Address - Street 1:2703 HALL ST
Mailing Address - Street 2:SUITE 10
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601-1964
Mailing Address - Country:US
Mailing Address - Phone:785-625-5678
Mailing Address - Fax:785-625-8204
Practice Address - Street 1:2703 HALL ST
Practice Address - Street 2:SUITE 10
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601-1964
Practice Address - Country:US
Practice Address - Phone:785-625-5678
Practice Address - Fax:785-625-8204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-13
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225C00000X, 251C00000X, 251E00000X, 3747P1801X
KS320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorGroup - Multi-Specialty
No251C00000XAgenciesDay Training, Developmentally Disabled ServicesGroup - Multi-Specialty
No251E00000XAgenciesHome Health
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100027880-AMedicaid