SHADY COTTAGE


Address: 1411 17th St, Belleville, KS 66935-3028
Phone: 7855272650

SHADY COTTAGE (NPI# 1700212248) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1700212248
Entity Type Organization
Organization Name SHADY COTTAGE
Practice Address 1411 17th St
Belleville
KS 66935-3028
Mailing Address 1302 K St
Belleville
KS 66935-1801
Practice Telephone 7855272650
Mailing Telephone 7855272729
Enumeration Date 2013-09-16
Last Update Date 2019-11-04
Authorized Official Name SAMANTHA JANE CLARK (OWNER)
Authorized Official Telephone 7855272729
Is Organization Subpart N

Taxonomy

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

Other Provider Identifier

State Issuer Identifier Type Code
KS KMAP ID NUMBER 200688530B 01

Office Location

Street Address 1411 17TH ST
City BELLEVILLE
State KS
Zip Code 66935-3028

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1881062578 Deanna Lynn Morris Respiratory Therapist, Registered 1331 18th St, Belleville, KS 66935 2015-09-11
1760713259 Duane Lee Scott Family Medicine 2714 M St., Belleville, KS 66935 2010-01-22
1013243666 Family Eye Care of Belleville Inc Optometrist 1704 M St, Belleville, KS 66935 2009-11-02
1164892345 Central Plains Respiratory & Medical, LLC Durable Medical Equipment & Medical Supplies 1331 18th St, Belleville, KS 66935 2015-10-01
1043556830 Lori Ann Weber Social Worker 1329 18th St, Belleville, KS 66935 2012-12-24
1841599289 Pet's Choice Pharmacy, LLC Pharmacy 814 K St, Belleville, KS 66935-1522 2011-03-24
1982765558 J Robert Arbuthnot Pharmacist 1806 M St, Belleville, KS 66935-2206 2006-12-13
1467431619 Candace Joan Fielder Social Worker 1836 M St, Belleville, KS 66935-2206 2006-01-14
1891796017 Arbuthnots Inc Pharmacy 1806 Main St, Belleville, KS 66935-2206 2005-08-10
1477615359 Kevin L Couture Pharmacist 1806 M St, Belleville, KS 66935-2206 2006-12-15
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Taxonomy Information

Taxonomy Code 320900000X
Grouping Residential Treatment Facilities
Classification Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities

Taxonomy Definition

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]

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1265952022 Arc of Essex County Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities 44 Maple Ave Apt 2, Belleville, NJ 07109-1320 2017-06-22
1154701050 The Arc of Essex County, Inc. Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities 44 Maple Ave Apt 1, Belleville, NJ 07109-1320 2015-06-05
1760711980 Support Systems and Services Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities 900 Royal Heights Rd, Belleville, IL 62226-5457 2009-12-17
1083736763 Orem Healthcare LLC Dba Sun Valley Adult Care Center Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities 3452 Middlebury Way, Belleville, IL 62221-3372 2007-04-04
1083128771 1st Cerebral Palsy of New Jersey Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities 7 Sanford Ave, Belleville, NJ 07109-1221 2017-11-17
1831544436 Caritas Family Solutions Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities 8601 W Main St Ste 201, Belleville, IL 62223-1719 2016-05-02
1003296880 The Arc of Essex County, Inc. Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities 10 Mount Pleasant Ave, Belleville, NJ 07109-2021 2015-06-05

Providers in the same taxonomy and state

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
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
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
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
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Competitor

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City BELLEVILLE
Zip Code 66935

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Dataset Information

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.

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