Provider Demographics
NPI:1013013846
Name:FRIENDS OF KANSAS CHRISTIAN HOME INC
Entity Type:Organization
Organization Name:FRIENDS OF KANSAS CHRISTIAN HOME INC
Other - Org Name:KANSAS CHRISTIAN HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HARLAND
Authorized Official - Suffix:
Authorized Official - Credentials:DPT, LNHA
Authorized Official - Phone:316-871-2677
Mailing Address - Street 1:1035 SE 3RD ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:KS
Mailing Address - Zip Code:67114-3904
Mailing Address - Country:US
Mailing Address - Phone:316-283-6600
Mailing Address - Fax:316-283-6375
Practice Address - Street 1:1035 SE 3RD ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:KS
Practice Address - Zip Code:67114-3904
Practice Address - Country:US
Practice Address - Phone:316-283-6600
Practice Address - Fax:316-283-6375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSN-040004313M00000X
KSN040004314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200366760AMedicaid
KS1581OtherBCBS OF KANSAS
KS200366760AMedicaid