Provider Demographics
NPI:1396173183
Name:ASPIE LIFE ADVENTURE LLC
Entity type:Organization
Organization Name:ASPIE LIFE ADVENTURE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:ANKENMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-669-9863
Mailing Address - Street 1:2002 E 35TH AVE
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:KS
Mailing Address - Zip Code:67502-1353
Mailing Address - Country:US
Mailing Address - Phone:620-669-9863
Mailing Address - Fax:
Practice Address - Street 1:912 W 18TH AVE
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:KS
Practice Address - Zip Code:67502-4140
Practice Address - Country:US
Practice Address - Phone:620-259-6171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-15
Last Update Date:2013-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200970100AMedicaid