Provider Demographics
NPI:1902040934
Name:DERBY RECOVERY CENTER, INC
Entity Type:Organization
Organization Name:DERBY RECOVERY CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/EXEC DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:KELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-788-1800
Mailing Address - Street 1:1721 E OSAGE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DERBY
Mailing Address - State:KS
Mailing Address - Zip Code:67037-2092
Mailing Address - Country:US
Mailing Address - Phone:316-788-1800
Mailing Address - Fax:316-788-1815
Practice Address - Street 1:1721 E OSAGE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:DERBY
Practice Address - State:KS
Practice Address - Zip Code:67037-2092
Practice Address - Country:US
Practice Address - Phone:316-788-1800
Practice Address - Fax:316-788-1815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-21
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS070909003245S0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children