Provider Demographics
NPI:1346213923
Name:ADDICTION TREATMENT CENTER OF SOUTHEAST KANSAS
Entity Type:Organization
Organization Name:ADDICTION TREATMENT CENTER OF SOUTHEAST KANSAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:H
Authorized Official - Last Name:PFEIFFER
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:620-231-5130
Mailing Address - Street 1:911 E CENTENNIAL DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:KS
Mailing Address - Zip Code:66762-6601
Mailing Address - Country:US
Mailing Address - Phone:620-231-5130
Mailing Address - Fax:620-235-7101
Practice Address - Street 1:810 CEDAR ST
Practice Address - Street 2:
Practice Address - City:GIRARD
Practice Address - State:KS
Practice Address - Zip Code:66743-2056
Practice Address - Country:US
Practice Address - Phone:620-724-8806
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CRAWFORD COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-02-13
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health