Provider Demographics
NPI:1932537214
Name:DOWN HOME SERVICE AND SUPPORTS
Entity Type:Organization
Organization Name:DOWN HOME SERVICE AND SUPPORTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DESSIE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-379-5651
Mailing Address - Street 1:926 SE TECUMSEH RD
Mailing Address - Street 2:
Mailing Address - City:TECUMSEH
Mailing Address - State:KS
Mailing Address - Zip Code:66542-9315
Mailing Address - Country:US
Mailing Address - Phone:785-379-5651
Mailing Address - Fax:785-379-9887
Practice Address - Street 1:926 SE TECUMSEH RD
Practice Address - Street 2:
Practice Address - City:TECUMSEH
Practice Address - State:KS
Practice Address - Zip Code:66542-9315
Practice Address - Country:US
Practice Address - Phone:785-379-5651
Practice Address - Fax:785-379-9887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-23
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200592300AMedicaid