Provider Demographics
NPI:1457681108
Name:LEAVENWORTH UNIFIED SCHOOL 453
Entity Type:Organization
Organization Name:LEAVENWORTH UNIFIED SCHOOL 453
Other - Org Name:LEAVENWORTH COUNTY SPECIAL EDUCATION COOOPERATIVE
Other - Org Type:Other Name
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GULLETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-684-1400
Mailing Address - Street 1:200 N 4TH ST
Mailing Address - Street 2:PO BOX 969
Mailing Address - City:LEAVENWORTH
Mailing Address - State:KS
Mailing Address - Zip Code:66048-1963
Mailing Address - Country:US
Mailing Address - Phone:913-684-1400
Mailing Address - Fax:913-684-1407
Practice Address - Street 1:210 E MARY ST
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:KS
Practice Address - Zip Code:66043-1633
Practice Address - Country:US
Practice Address - Phone:913-727-1755
Practice Address - Fax:913-727-1602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-31
Last Update Date:2009-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100212020AMedicaid