Provider Demographics
NPI:1477522134
Name:ARROWHEAD WEST, INC.
Entity Type:Organization
Organization Name:ARROWHEAD WEST, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:PENDERGAST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-227-8803
Mailing Address - Street 1:1100 E WYATT EARP BLVD
Mailing Address - Street 2:
Mailing Address - City:DODGE CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67801-5337
Mailing Address - Country:US
Mailing Address - Phone:620-227-8803
Mailing Address - Fax:620-227-8812
Practice Address - Street 1:9505 W CENTRAL AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-3831
Practice Address - Country:US
Practice Address - Phone:620-227-8803
Practice Address - Fax:620-227-8812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered251C00000XAgenciesDay Training, Developmentally Disabled Services
Not Answered320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Not Answered3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty