Provider Demographics
NPI:1306563804
Name:MID KANSAS DISABILITY CARE,LLC
Entity type:Organization
Organization Name:MID KANSAS DISABILITY CARE,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KYLEE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GRAGG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-416-0773
Mailing Address - Street 1:563 BERKSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-3307
Mailing Address - Country:US
Mailing Address - Phone:785-419-0773
Mailing Address - Fax:
Practice Address - Street 1:563 BERKSHIRE DR
Practice Address - Street 2:
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401-3307
Practice Address - Country:US
Practice Address - Phone:785-419-0773
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-25
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services