Provider Demographics
NPI:1356479208
Name:CREATIVE COMMUNITY LIVING OF SOUTH CENTRAL KANSAS, INC.
Entity Type:Organization
Organization Name:CREATIVE COMMUNITY LIVING OF SOUTH CENTRAL KANSAS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMI
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-221-9431
Mailing Address - Street 1:1500 E 8TH AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WINFIELD
Mailing Address - State:KS
Mailing Address - Zip Code:67156-3104
Mailing Address - Country:US
Mailing Address - Phone:620-221-9431
Mailing Address - Fax:620-221-9336
Practice Address - Street 1:1500 E 8TH AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:WINFIELD
Practice Address - State:KS
Practice Address - Zip Code:67156-3104
Practice Address - Country:US
Practice Address - Phone:620-221-9431
Practice Address - Fax:620-221-9336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health