Provider Demographics
NPI:1043308489
Name:CATHOLIC CHARITIES OF NORTHEAST KANSAS INC
Entity Type:Organization
Organization Name:CATHOLIC CHARITIES OF NORTHEAST KANSAS INC
Other - Org Name:CATHOLIC COMMUNITY SERVICES HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR, HEALTHCARE
Authorized Official - Prefix:MS
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:A
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-433-2012
Mailing Address - Street 1:9740 W 87TH ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66212-4563
Mailing Address - Country:US
Mailing Address - Phone:913-621-5090
Mailing Address - Fax:913-371-3080
Practice Address - Street 1:405 NE 70TH ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64118-2530
Practice Address - Country:US
Practice Address - Phone:816-523-5634
Practice Address - Fax:913-371-3080
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CATHOLIC CHARITIES OF NORTHEAST KANSAS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-11
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO239-22HH251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO582230900Medicaid