Provider Demographics
NPI:1104190263
Name:KRCAREGIVER
Entity Type:Organization
Organization Name:KRCAREGIVER
Other - Org Name:KRCAREGIVER
Other - Org Type:Other Name
Authorized Official - Title/Position:CARE GIVER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:FIRST AID AND CPR
Authorized Official - Phone:316-253-4101
Mailing Address - Street 1:1508 MILLS CIR APT#1
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67216-1893
Mailing Address - Country:US
Mailing Address - Phone:316-253-4101
Mailing Address - Fax:
Practice Address - Street 1:1508 MILLS CIR APT#1
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67216-1893
Practice Address - Country:US
Practice Address - Phone:316-253-4101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-06
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities