Provider Demographics
NPI:1568658656
Name:SELECTRA ONESOURCE, INC.
Entity Type:Organization
Organization Name:SELECTRA ONESOURCE, INC.
Other - Org Name:SELECTRA HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHANIA
Authorized Official - Middle Name:LATRICE
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-822-1000
Mailing Address - Street 1:1734 E 63RD ST
Mailing Address - Street 2:448
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64110-3543
Mailing Address - Country:US
Mailing Address - Phone:816-822-1000
Mailing Address - Fax:816-822-1040
Practice Address - Street 1:1734 E 63RD ST
Practice Address - Street 2:448
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64110-3543
Practice Address - Country:US
Practice Address - Phone:816-822-1000
Practice Address - Fax:816-822-1040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-21
Last Update Date:2008-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities