Provider Demographics
NPI:1003088998
Name:CRAIG RESOURCES, INC.
Entity Type:Organization
Organization Name:CRAIG RESOURCES, INC.
Other - Org Name:CRAIG HOMECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BALKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-266-8722
Mailing Address - Street 1:1220 E 1ST ST N
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67214-3907
Mailing Address - Country:US
Mailing Address - Phone:316-266-8717
Mailing Address - Fax:316-266-8757
Practice Address - Street 1:5661 TELEGRAPH RD STE 5B
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63129-4275
Practice Address - Country:US
Practice Address - Phone:314-843-0316
Practice Address - Fax:314-843-0317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-31
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0009412251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO0009412OtherMISSOURI SSBG/GR PROVIDER
MO945429900Medicaid