1609202548 NPI number — A NEW DAY AT HOME SUNFLOWER HOUSE

Table of content: LAUREN NICOLE FETTIS BCBA (NPI 1285372151)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609202548 NPI number — A NEW DAY AT HOME SUNFLOWER HOUSE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
A NEW DAY AT HOME SUNFLOWER HOUSE
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:
Provider Other Organization Name Type Code:
6
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:
1609202548
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/24/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10540 BARKLEY ST
Provider Second Line Business Mailing Address:
SUITE 205
Provider Business Mailing Address City Name:
OVERLAND PARK
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66212-1811
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10540 BARKLEY ST
Provider Second Line Business Practice Location Address:
SUITE 205
Provider Business Practice Location Address City Name:
OVERLAND PARK
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66212-1811
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-440-0204
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/24/2013

Additional Information

Authorized Official

Authorized Official Last Name:
GRANT
Authorized Official First Name:
NORMAN
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGING DIRECTOR
Authorized Official Telephone Number:
913-440-0204

Provider Taxonomy Codes

  • Taxonomy code: 311ZA0620X , with the licence number:  B046052 , 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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