Basic Information
| Provider Information | |||||||||
| NPI: | 1932275526 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PREFERRED FAMILY HEALTHCARE, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 900 E LAHARPE ST | ||||||||
| Address2: | PO BOX 767 | ||||||||
| City: | KIRKSVILLE | ||||||||
| State: | MO | ||||||||
| PostalCode: | 635014520 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6606651962 | ||||||||
| FaxNumber: | 6606653989 | ||||||||
| Practice Location | |||||||||
| Address1: | 830 S HILLSIDE ST | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672113004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3166132222 | ||||||||
| FaxNumber: | 3166132220 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/27/2006 | ||||||||
| LastUpdateDate: | 07/29/2020 | ||||||||
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| AuthorizedOfficialLastName: | CONOVER | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
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| AuthorizedOfficialTitleorPosition: | COO | ||||||||
| AuthorizedOfficialTelephone: | 6606651962 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | PREFERRED FAMILY HEALTHCARE, INC. | ||||||||
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| NPICertificationDate: | 07/29/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | 541 574 613 629 | KS | N | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Case Manager/Care Coordinator | 324500000X | 541 574 613 | KS | N | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility | 3245S0500X | 541 649 | KS | N | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility | Substance Abuse Treatment, Children | 101YA0400X | 629 | KS | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
ID Information
| ID | Type | State | Issuer | Description | 001579 | 01 | BCBS | OTHER | 100449090TA | 05 | KS | MEDICAID | 116054 | 01 | BCBS | OTHER |