Provider Demographics
NPI:1992828362
Name:THE SWEET LIFE AT SHAWNEE
Entity Type:Organization
Organization Name:THE SWEET LIFE AT SHAWNEE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:913-248-1500
Mailing Address - Street 1:11400 W 65TH ST
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66203-5555
Mailing Address - Country:US
Mailing Address - Phone:913-248-1500
Mailing Address - Fax:913-248-0030
Practice Address - Street 1:11400 W 65TH ST
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66203-5555
Practice Address - Country:US
Practice Address - Phone:913-248-1500
Practice Address - Fax:913-248-0030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSNO46053323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility