Provider Demographics
NPI:1740909316
Name:FAMILY DEVELOPMENTAL SUPPORT LLC
Entity type:Organization
Organization Name:FAMILY DEVELOPMENTAL SUPPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GOSBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:BANTURAKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-634-9411
Mailing Address - Street 1:8700 MONROVIA ST
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66215-3500
Mailing Address - Country:US
Mailing Address - Phone:913-634-9411
Mailing Address - Fax:
Practice Address - Street 1:8700 MONROVIA ST
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66215-3500
Practice Address - Country:US
Practice Address - Phone:913-634-9411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-25
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services