Provider Demographics
NPI:1174917660
Name:MIDLAND CARE CONNECTION, INC
Entity type:Organization
Organization Name:MIDLAND CARE CONNECTION, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-232-2044
Mailing Address - Street 1:200 SW FRAZIER CIR
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66606-2800
Mailing Address - Country:US
Mailing Address - Phone:785-232-2044
Mailing Address - Fax:785-232-5567
Practice Address - Street 1:200 SW FRAZIER CIR
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66606-2800
Practice Address - Country:US
Practice Address - Phone:785-232-2044
Practice Address - Fax:785-232-5567
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MIDLAND CARE CONNECTION, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-03-24
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSA089038253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100117670CMedicaid