Provider Demographics
NPI:1285637884
Name:VIA CHRISTI VILLAGE PITTSBURG INC
Entity Type:Organization
Organization Name:VIA CHRISTI VILLAGE PITTSBURG INC
Other - Org Name:CORNERSTONE VILLAGE, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:EWAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-235-0020
Mailing Address - Street 1:1502 E CENTENNIAL DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:KS
Mailing Address - Zip Code:66762-6718
Mailing Address - Country:US
Mailing Address - Phone:620-235-0020
Mailing Address - Fax:620-235-0520
Practice Address - Street 1:1502 E CENTENNIAL DR
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:KS
Practice Address - Zip Code:66762-6718
Practice Address - Country:US
Practice Address - Phone:620-235-0020
Practice Address - Fax:620-235-0520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-27
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSN019013310400000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100455940BOtherHCBS
KS100455940AMedicaid
KS100455940BOtherHCBS