Provider Demographics
NPI:1053160531
Name:TARGETED CASE MANAGEMENT SERVICES OF KANSAS
Entity type:Organization
Organization Name:TARGETED CASE MANAGEMENT SERVICES OF KANSAS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:WREN
Authorized Official - Last Name:OTTO
Authorized Official - Suffix:
Authorized Official - Credentials:MED; MPA
Authorized Official - Phone:913-229-3643
Mailing Address - Street 1:5916 DEARBORN ST
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66202-3316
Mailing Address - Country:US
Mailing Address - Phone:913-229-3643
Mailing Address - Fax:
Practice Address - Street 1:5916 DEARBORN ST
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:KS
Practice Address - Zip Code:66202-3316
Practice Address - Country:US
Practice Address - Phone:913-229-3643
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-16
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS30005167300001Medicaid