Provider Demographics
NPI:1356912414
Name:KIDSTLC, INC
Entity type:Organization
Organization Name:KIDSTLC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE VP REFERRALS & ADMISSIONS
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:HENTCHEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-226-2430
Mailing Address - Street 1:480 S ROGERS RD
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-1706
Mailing Address - Country:US
Mailing Address - Phone:913-764-2887
Mailing Address - Fax:913-768-1437
Practice Address - Street 1:480 S ROGERS RD
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-1706
Practice Address - Country:US
Practice Address - Phone:913-764-2887
Practice Address - Fax:913-768-1437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-08
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility