Provider Demographics
NPI:1720253727
Name:SELECTRA ONESOURCE, INC.
Entity Type:Organization
Organization Name:SELECTRA ONESOURCE, INC.
Other - Org Name:SELECTRA HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHANIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-822-1000
Mailing Address - Street 1:1734 E 63RD STREET
Mailing Address - Street 2:SUITE 448
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64110-3597
Mailing Address - Country:US
Mailing Address - Phone:816-822-1000
Mailing Address - Fax:816-822-1040
Practice Address - Street 1:1734 E 63RD STREET
Practice Address - Street 2:SUITE 448
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64110-3597
Practice Address - Country:US
Practice Address - Phone:816-822-1000
Practice Address - Fax:816-822-1040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-30
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO286226105376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO286226105Medicaid