Provider Demographics
NPI: | 1710315411 |
---|---|
Name: | THE GREEN EXPRESS STUDIO |
Entity Type: | Organization |
Organization Name: | THE GREEN EXPRESS STUDIO |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | EXECUTIVE DIRECTOR |
Authorized Official - Prefix: | MISS |
Authorized Official - First Name: | HARRIET |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | SORE |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 913-381-0607 |
Mailing Address - Street 1: | 8029 OVERLAND PARK DR |
Mailing Address - Street 2: | |
Mailing Address - City: | OVERLAND PARK |
Mailing Address - State: | KS |
Mailing Address - Zip Code: | 66204-3744 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 913-381-0607 |
Mailing Address - Fax: | 913-381-0607 |
Practice Address - Street 1: | 8029 OVERLAND PARK DR |
Practice Address - Street 2: | |
Practice Address - City: | OVERLAND PARK |
Practice Address - State: | KS |
Practice Address - Zip Code: | 66204-3744 |
Practice Address - Country: | US |
Practice Address - Phone: | 913-381-0607 |
Practice Address - Fax: | 913-381-0607 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2013-10-16 |
Last Update Date: | 2013-10-16 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
KS | 251C00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 251C00000X | Agencies | Day Training, Developmentally Disabled Services |