Provider Demographics
NPI:1538509104
Name:THE LOOKING GLASS DAY SERVICES
Entity type:Organization
Organization Name:THE LOOKING GLASS DAY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:WARES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-351-7554
Mailing Address - Street 1:602 S CHAUTAUQUA AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67211-3007
Mailing Address - Country:US
Mailing Address - Phone:316-351-7554
Mailing Address - Fax:316-351-7554
Practice Address - Street 1:602 S CHAUTAUQUA AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67211-3007
Practice Address - Country:US
Practice Address - Phone:316-351-7554
Practice Address - Fax:316-351-7554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-27
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200602870AOtherKMAP PROVIDER NUMBER