Provider Demographics
NPI:1295341758
Name:PERFECT FIT FOUNDATION OF SWK LLC
Entity type:Organization
Organization Name:PERFECT FIT FOUNDATION OF SWK LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:TRISTA
Authorized Official - Middle Name:
Authorized Official - Last Name:FERGERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-490-3643
Mailing Address - Street 1:PO BOX 1884
Mailing Address - Street 2:
Mailing Address - City:DODGE CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67801-1884
Mailing Address - Country:US
Mailing Address - Phone:620-253-2920
Mailing Address - Fax:620-371-6570
Practice Address - Street 1:2603 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:DODGE CITY
Practice Address - State:KS
Practice Address - Zip Code:67801-6210
Practice Address - Country:US
Practice Address - Phone:620-253-2920
Practice Address - Fax:620-371-6570
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PERFECT FIT FOUNDATION OF SWK LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-09-21
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201329860AMedicaid