Basic Information
| Provider Information | |||||||||
| NPI: | 1609067693 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KVC BEHAVIORAL HEALTHCARE, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 21350 W 153RD ST | ||||||||
| Address2: | |||||||||
| City: | OLATHE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660615413 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9133224900 | ||||||||
| FaxNumber: | 9136215730 | ||||||||
| Practice Location | |||||||||
| Address1: | 21350 W 153RD ST | ||||||||
| Address2: | |||||||||
| City: | OLATHE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660615413 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9133224900 | ||||||||
| FaxNumber: | 9136215730 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/06/2007 | ||||||||
| LastUpdateDate: | 08/06/2007 | ||||||||
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| AuthorizedOfficialLastName: | SIMS | ||||||||
| AuthorizedOfficialFirstName: | B. | ||||||||
| AuthorizedOfficialMiddleName: | WAYNE | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT AND CEO | ||||||||
| AuthorizedOfficialTelephone: | 9133224900 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
No ID Information.