Shady Cottage

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

Legal business name

SHADY COTTAGE

Practice address

1411 17TH St
Belleville, KS 66935-3028

Phone

(785) 527-2650

NPI assigned

Sep 16, 2013

Last updated

Nov 4, 2019By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Samantha Jane Clark

Title

Owner

Phone

(785) 527-2729

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1379289600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1572825600000",
    "number": "1700212248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1302 K ST",
            "city": "BELLEVILLE",
            "state": "KS",
            "postal_code": "669351801",
            "telephone_number": "785-527-2729"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1411 17TH ST",
            "city": "BELLEVILLE",
            "state": "KS",
            "postal_code": "669353028",
            "telephone_number": "785-527-2650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHADY COTTAGE",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-16",
        "last_updated": "2019-11-04",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "SAMANTHA",
        "authorized_official_middle_name": "JANE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "785-527-2729"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "KS",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KMAP ID NUMBER",
            "identifier": "200688530B",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.