Provider Demographics
NPI:1831363324
Name:LIFE PATTERNS
Entity type:Organization
Organization Name:LIFE PATTERNS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:P
Authorized Official - Last Name:GERDEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-273-7189
Mailing Address - Street 1:3625 SW 29TH ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66614-2061
Mailing Address - Country:US
Mailing Address - Phone:785-273-7189
Mailing Address - Fax:785-273-3816
Practice Address - Street 1:3625 SW 29TH ST
Practice Address - Street 2:SUITE 202
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66614-2061
Practice Address - Country:US
Practice Address - Phone:785-273-7189
Practice Address - Fax:785-273-3816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-16
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100033260BMedicaid