Provider Demographics
NPI:1477521151
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:PO BOX 310
Mailing Address - Street 2:
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601-0310
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:2006-03-09
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100006940PMedicaid