Provider Demographics
NPI:1336263052
Name:EMBERHOPE, INC
Entity Type:Organization
Organization Name:EMBERHOPE, INC
Other - Org Name:EMBERHOPE, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:NICKAILA
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDATE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-202-4989
Mailing Address - Street 1:PO 210
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:KS
Mailing Address - Zip Code:67114-0210
Mailing Address - Country:US
Mailing Address - Phone:316-283-1950
Mailing Address - Fax:316-529-9351
Practice Address - Street 1:900 W. BROADWAY
Practice Address - Street 2:BUILDING 6
Practice Address - City:NEWTON
Practice Address - State:KS
Practice Address - Zip Code:67114-2037
Practice Address - Country:US
Practice Address - Phone:316-283-1950
Practice Address - Fax:316-529-9351
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNITED METHODIST YOUTHVILLE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-19
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS003255006323P00000X, 323P00000X
323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100007290CMedicaid