Provider Demographics
NPI:1174513444
Name:JOHNSON COUNTY MENTAL HEALTH CENTER
Entity type:Organization
Organization Name:JOHNSON COUNTY MENTAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:QUALITY IMPROVEMENT REPRESENTATIVE
Authorized Official - Prefix:
Authorized Official - First Name:LYDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LONGORIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-826-4200
Mailing Address - Street 1:6000 LAMAR AVE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66202-3234
Mailing Address - Country:US
Mailing Address - Phone:913-826-4200
Mailing Address - Fax:913-826-1608
Practice Address - Street 1:6000 LAMAR AVE
Practice Address - Street 2:SUITE 130
Practice Address - City:MISSION
Practice Address - State:KS
Practice Address - Zip Code:66202-3234
Practice Address - Country:US
Practice Address - Phone:913-826-4200
Practice Address - Fax:913-826-1608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-26
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS30003914730021Medicaid
KS100098010DMedicaid
KS2920000BOtherMEDICARE PTAN
KS2920000AOtherMEDICARE PTAN
KS30003914730001Medicaid
KS30003914730015Medicaid
KS100098010FMedicaid
KS100098010JMedicaid
KS30003914730011Medicaid
KS30003914730013Medicaid
KS2920000COtherMEDICARE PTAN
KS30003914730012Medicaid