Provider Demographics
NPI:1841625605
Name:EXCLUSIVE LIVING RESOURCES INC.
Entity type:Organization
Organization Name:EXCLUSIVE LIVING RESOURCES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXCUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KIRK
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:BAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-363-1337
Mailing Address - Street 1:512 S KENTUCKY ST
Mailing Address - Street 2:
Mailing Address - City:IOLA
Mailing Address - State:KS
Mailing Address - Zip Code:66749-3910
Mailing Address - Country:US
Mailing Address - Phone:620-363-1337
Mailing Address - Fax:
Practice Address - Street 1:512 S KENTUCKY ST
Practice Address - Street 2:
Practice Address - City:IOLA
Practice Address - State:KS
Practice Address - Zip Code:66749-3910
Practice Address - Country:US
Practice Address - Phone:620-363-1337
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-11
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS200877210A251C00000X, 320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200877210AMedicaid