Provider Demographics
NPI:1568507127
Name:CEREBRAL PALSY RESEARCH FOUNDATION OF KANSAS, INC
Entity type:Organization
Organization Name:CEREBRAL PALSY RESEARCH FOUNDATION OF KANSAS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROCKMEYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-688-1888
Mailing Address - Street 1:5111 E 21ST ST N
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-1606
Mailing Address - Country:US
Mailing Address - Phone:316-688-1888
Mailing Address - Fax:316-651-5219
Practice Address - Street 1:5111 E 21ST ST N
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-1606
Practice Address - Country:US
Practice Address - Phone:316-688-1888
Practice Address - Fax:316-651-5219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)Group - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No251B00000XAgenciesCase ManagementGroup - Multi-Specialty
No251E00000XAgenciesHome Health
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100008150AMedicaid
KS004947OtherCOMMON PAY NUMBER
KS100028820AMedicaid
KS100008150BMedicaid
KS100008150DMedicaid