Provider Demographics
NPI:1679573554
Name:PARSONS STATE HOSPITAL AND TRAINING CENTER
Entity Type:Organization
Organization Name:PARSONS STATE HOSPITAL AND TRAINING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACTING SUPERINTENDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:REA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:620-421-6550
Mailing Address - Street 1:2601 GABRIEL AVE
Mailing Address - Street 2:
Mailing Address - City:PARSONS
Mailing Address - State:KS
Mailing Address - Zip Code:67357-2341
Mailing Address - Country:US
Mailing Address - Phone:620-421-6550
Mailing Address - Fax:620-421-3623
Practice Address - Street 1:2601 GABRIEL AVE
Practice Address - Street 2:
Practice Address - City:PARSONS
Practice Address - State:KS
Practice Address - Zip Code:67357-2341
Practice Address - Country:US
Practice Address - Phone:620-421-6550
Practice Address - Fax:620-421-3623
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSM050101315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS016493Medicare ID - Type UnspecifiedPROVIDER NUMBER