Provider Demographics
NPI:1114920980
Name:STATE OF KANSAS
Entity type:Organization
Organization Name:STATE OF KANSAS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:ASHCRAFT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-755-7073
Mailing Address - Street 1:500 STATE HOSPITAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:OSAWATOMIE
Mailing Address - State:KS
Mailing Address - Zip Code:66064-0500
Mailing Address - Country:US
Mailing Address - Phone:913-755-7312
Mailing Address - Fax:913-755-7127
Practice Address - Street 1:2205 WEST 36TH AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66103-2198
Practice Address - Country:US
Practice Address - Phone:913-789-5800
Practice Address - Fax:913-755-7127
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STATE OF KANSAS DBA RAINBOW MENTAL HEALTH FACILITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-05-24
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSM105001283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100101140AMedicaid
174010Medicare Oscar/Certification