Provider Demographics
NPI:1356900286
Name:RESIDENTIAL TREATMENT SERVICES OF SOUTHEAST KANSAS, LLC
Entity type:Organization
Organization Name:RESIDENTIAL TREATMENT SERVICES OF SOUTHEAST KANSAS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:620-421-1155
Mailing Address - Street 1:PO BOX 1174
Mailing Address - Street 2:
Mailing Address - City:PARSONS
Mailing Address - State:KS
Mailing Address - Zip Code:67357-1174
Mailing Address - Country:US
Mailing Address - Phone:620-421-1155
Mailing Address - Fax:620-421-1156
Practice Address - Street 1:4919 MAIN ST.
Practice Address - Street 2:
Practice Address - City:PARSONS
Practice Address - State:KS
Practice Address - Zip Code:67357-1174
Practice Address - Country:US
Practice Address - Phone:620-421-1155
Practice Address - Fax:620-421-1156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-13
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251C00000XAgenciesDay Training, Developmentally Disabled Services