1003964875 NPI number — MARILLAC CENTER, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003964875 NPI number — MARILLAC CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARILLAC CENTER, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CHILDREN'S PSYCHIATRIC HOSPITAL OF MARILLAC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003964875
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8000 W 127TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OVERLAND PARK
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66213-2714
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-805-3300
Provider Business Mailing Address Fax Number:
816-508-3321

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8000 W 127TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OVERLAND PARK
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66213-2714
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-805-3300
Provider Business Practice Location Address Fax Number:
816-508-3321
Provider Enumeration Date:
01/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
RICHARDS
Authorized Official First Name:
MARK
Authorized Official Middle Name:
S
Authorized Official Title or Position:
PRESIDENT CEO
Authorized Official Telephone Number:
816-508-3300

Provider Taxonomy Codes

  • Taxonomy code: 283Q00000X , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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