Basic Information
| Provider Information | |||||||||
| NPI: | 1083644991 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | VALLEY HOPE ASSOCIATION | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | OVERLAND PARK VALLEY HOPE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 510 | ||||||||
| Address2: | VALLEY HOPE ASSOCIATION | ||||||||
| City: | NORTON | ||||||||
| State: | KS | ||||||||
| PostalCode: | 67654 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7858775111 | ||||||||
| FaxNumber: | 7858772322 | ||||||||
| Practice Location | |||||||||
| Address1: | 10955 GRANADA LN | ||||||||
| Address2: | |||||||||
| City: | OVERLAND PARK | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662111440 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9134324037 | ||||||||
| FaxNumber: | 9134320406 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/04/2006 | ||||||||
| LastUpdateDate: | 04/06/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | ERBERT | ||||||||
| AuthorizedOfficialFirstName: | KATHY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR OF CONTRACT ADMINISTRATION | ||||||||
| AuthorizedOfficialTelephone: | 7858775111 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | VALLEY HOPE ASSOCIATION | ||||||||
| AuthorizedOfficialNamePrefix: | MS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 04/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0405X | 00870065 | KS | Y | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder |
ID Information
| ID | Type | State | Issuer | Description | 461414 | 01 | VALUE OPTIONS PROVIDER # | OTHER |