Provider Demographics
NPI:1275683260
Name:SOUTHEAST KANSAS INDEPENDENT LIVING RESOURCE CENTER INC
Entity Type:Organization
Organization Name:SOUTHEAST KANSAS INDEPENDENT LIVING RESOURCE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHARI
Authorized Official - Middle Name:J
Authorized Official - Last Name:COATNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-421-5502
Mailing Address - Street 1:PO BOX 957
Mailing Address - Street 2:
Mailing Address - City:PARSONS
Mailing Address - State:KS
Mailing Address - Zip Code:67357-0957
Mailing Address - Country:US
Mailing Address - Phone:620-421-5502
Mailing Address - Fax:620-421-3705
Practice Address - Street 1:1801 MAIN ST
Practice Address - Street 2:
Practice Address - City:PARSONS
Practice Address - State:KS
Practice Address - Zip Code:67357-3367
Practice Address - Country:US
Practice Address - Phone:620-421-5502
Practice Address - Fax:620-421-3705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
No251B00000XAgenciesCase Management
No251E00000XAgenciesHome Health
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100021850 AMedicaid
KS100021850 BMedicaid
KS100021850 DMedicaid
KS100025230 AMedicaid
KS100042860 AMedicaid