Provider Demographics
NPI:1508949520
Name:SWORD OF CHANGE ADDICTION & RECOVERY SERVICES, LLC
Entity Type:Organization
Organization Name:SWORD OF CHANGE ADDICTION & RECOVERY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:I
Authorized Official - Last Name:ECORD
Authorized Official - Suffix:
Authorized Official - Credentials:BAS
Authorized Official - Phone:785-266-4242
Mailing Address - Street 1:701 SW JACKSON ST
Mailing Address - Street 2:SUITE 207
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66603-3700
Mailing Address - Country:US
Mailing Address - Phone:785-266-4242
Mailing Address - Fax:785-266-4242
Practice Address - Street 1:701 SW JACKSON ST
Practice Address - Street 2:SUITE 207
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66603-3700
Practice Address - Country:US
Practice Address - Phone:785-266-4242
Practice Address - Fax:785-266-4242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty