Provider Demographics
NPI:1568681518
Name:JOHNSON COUNTY DEVELOPMENTAL SUPPORTS
Entity Type:Organization
Organization Name:JOHNSON COUNTY DEVELOPMENTAL SUPPORTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KARLA
Authorized Official - Middle Name:J
Authorized Official - Last Name:GRAVENSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-826-2638
Mailing Address - Street 1:10501 LACKMAN RD
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66219-1223
Mailing Address - Country:US
Mailing Address - Phone:913-826-2626
Mailing Address - Fax:913-826-2627
Practice Address - Street 1:10501 LACKMAN RD
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66219-1223
Practice Address - Country:US
Practice Address - Phone:913-826-2626
Practice Address - Fax:913-826-2627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSKSA753307B251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health