Provider Demographics
NPI:1073624607
Name:COUNTY OF REPUBLIC
Entity Type:Organization
Organization Name:COUNTY OF REPUBLIC
Other - Org Name:REPUBLIC CO. HEALTH DEPT/HOME HEALTH AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SWANSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:785-527-5671
Mailing Address - Street 1:2316 G ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:66935-2452
Mailing Address - Country:US
Mailing Address - Phone:785-527-5671
Mailing Address - Fax:785-527-2892
Practice Address - Street 1:2316 G ST
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:KS
Practice Address - Zip Code:66935-2452
Practice Address - Country:US
Practice Address - Phone:785-527-5671
Practice Address - Fax:785-527-2892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSA-079-001251E00000X
N/A251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100089410BMedicaid
KS00658OtherBCBS HOMEHEALTH
KS012767OtherBCBS PUBLIC HEALTH
KS100089410AMedicaid
KS100071930AMedicaid
KS100089410AMedicaid