Provider Demographics
NPI:1629159389
Name:WYANDOT CENTER FOR COMMUNITY BEHAVIORAL HEALTHCARE, INC.
Entity Type:Organization
Organization Name:WYANDOT CENTER FOR COMMUNITY BEHAVIORAL HEALTHCARE, INC.
Other - Org Name:WYANDOT INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:MAIWALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-233-3300
Mailing Address - Street 1:757 ARMSTRONG AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66101-2701
Mailing Address - Country:US
Mailing Address - Phone:913-233-3300
Mailing Address - Fax:913-233-3390
Practice Address - Street 1:1301 N 47TH ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66102-1705
Practice Address - Country:US
Practice Address - Phone:913-287-0007
Practice Address - Fax:913-233-3350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS251S00000X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS30003913810001Medicaid
KS100098080CMedicaid
KS100098080AMedicaid