Provider Demographics
NPI:1730500539
Name:SUNFLOWER DIVERSIFIED SERVICES INC
Entity Type:Organization
Organization Name:SUNFLOWER DIVERSIFIED SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-792-1325
Mailing Address - Street 1:8823 4TH ST
Mailing Address - Street 2:
Mailing Address - City:GREAT BEND
Mailing Address - State:KS
Mailing Address - Zip Code:67530-1000
Mailing Address - Country:US
Mailing Address - Phone:620-792-1321
Mailing Address - Fax:620-792-7409
Practice Address - Street 1:8823 4TH ST
Practice Address - Street 2:
Practice Address - City:GREAT BEND
Practice Address - State:KS
Practice Address - Zip Code:67530-1000
Practice Address - Country:US
Practice Address - Phone:620-792-1321
Practice Address - Fax:620-792-7409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-20
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No251C00000XAgenciesDay Training, Developmentally Disabled Services