STACEY EVANS S.E. ENTERPRISES (NPI# 1366873788) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1366873788 |
| Entity Type | Organization |
| Organization Name | STACEY EVANS S.E. ENTERPRISES |
| Practice Address |
11702 W Kenny Ln Wichita KS 67212-6649 |
| Practice Telephone | 3167221626 |
| Practice Fax Number | 3167221626 |
| Mailing Telephone | 3167221626 |
| Mailing Fax Number | 3167221626 |
| Enumeration Date | 2013-12-11 |
| Last Update Date | 2013-12-11 |
| Authorized Official Name | STACEY EVANS (OWNER) |
| Authorized Official Telephone | 3167221626 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 320900000X | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | KS | Residential Treatment Facilities |
| Street Address |
11702 W KENNY LN |
| City | WICHITA |
| State | KS |
| Zip Code | 67212-6649 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376198721 | Dwell, LLC | Community Health Worker | 11702 W Kenny Ln, Wichita, KS 67212-6649 | 2019-08-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891396974 | Kim Deann Kercher | Physical Therapist | Legacy At Grassland Estates, 10665 W 13th St N Apt 329, Wichita, KS 67212 | 2020-11-04 |
| 1700370954 | Andrea Lou Wheeler | Registered Nurse | 658 N Fairway Ave, Wichita, KS 67212 | 2018-06-20 |
| 1568981231 | Wichita Family Dental LLC | Dentist | 1445 N. Ridge Rd, Wichtia, KS 67212 | 2017-09-14 |
| 1396260121 | Keegan Hemberger | Pharmacist | 555 N. Maize Road, Wichita, KS 67212 | 2017-08-14 |
| 1154877603 | Alicia Rose Landrum | Counselor | 515 N Ridge Rd Ste 105, Wichita, KS 67212 | 2016-08-25 |
| 1306218920 | Brandee Young | Occupational Therapist | 9710 W. Jamesburg, Wichita, KS 67212 | 2015-10-22 |
| 1588072201 | Michelle Kuhn | Pharmacist | 10515 W Central, Wichita, KS 67212 | 2014-07-25 |
| 1972914083 | Linda Mueller Mueller | Marriage & Family Therapist | 4425 West Zoo Blvd, Wichita, KS 67212 | 2014-05-12 |
| 1619392305 | Jessica Smith | Counselor | 1319 W May, Wichita, KS 67212 | 2014-03-04 |
| 1245652064 | Keepsake Kottage, LLC | Custodial Care Facility | 8801 W Bekemeyer, Wichita, KS 67212 | 2014-01-14 |
| Find all providers in zip 67212 | ||||
| Taxonomy Code | 320900000X |
| Grouping | Residential Treatment Facilities |
| Classification | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities |
| A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124630132 | Elite Adult Living LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 5001 Looman St, Wichita, KS 67220-3030 | 2020-08-20 |
| 1366861197 | Karen Frye | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 4214 N 143rd St E, Wichita, KS 67228-8943 | 2014-04-09 |
| 1164561486 | The Right Thing Inc. | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 3330 W. Douglas, Ste. #300, Wichita, KS 67203 | 2007-02-05 |
| 1477522134 | Arrowhead West, Inc. | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 9505 W Central Ave, Suite 110, Wichita, KS 67212-3831 | 2006-03-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720603186 | Beverly Jean Weber Cobb | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 3829 Sw Wood Valley Dr, Topeka, KS 66610-1124 | 2020-06-11 |
| 1073174918 | Keith Lavelle Kerr Jr. | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 2914 N 38th St, Kansas City, KS 66104-2526 | 2019-06-21 |
| 1912444548 | Developmental Services of Northwest Kansas, Inc. | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 2703 Hall St Ste 10, Hays, KS 67601-1964 | 2017-01-20 |
| 1255785275 | Lindsey Marts | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 8809 Grandview St, Overland Park, KS 66212-3643 | 2016-04-15 |
| 1952774184 | Joyce's New Vision LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1801 S 40th St, Kansas City, KS 66106-2607 | 2015-11-10 |
| 1336518976 | Pearlie Mae's Compassion and Care | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 2956 Sw Seabrook Ave, Topeka, KS 66614 | 2015-09-24 |
| 1427474485 | Joyce Ann Maley | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1036 2200th St, Iola, KS 66749-3085 | 2014-03-13 |
| 1174947113 | Avance-d Comminuty Alternatives, LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 7424 Sw 33rd St, Topeka, KS 66614-4663 | 2014-02-11 |
| 1346661485 | Lawrence Comunity Innkeepers | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1095 N 1750 Rd, Lawrence, KS 66049-9019 | 2013-12-16 |
| 1265860902 | Joyce Butler | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 3515 N 33rd Ter, Kansas City, KS 66104-3874 | 2013-10-16 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.