Provider Demographics
NPI:1336118397
Name:COMMUNITY HOSPITAL ASSOCIATION
Entity Type:Organization
Organization Name:COMMUNITY HOSPITAL ASSOCIATION
Other - Org Name:COMMUNITY HOSPITAL HOME HEALTH AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MYRA
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-686-2211
Mailing Address - Street 1:26136 US HIGHWAY 59
Mailing Address - Street 2:P.O. BOX 107
Mailing Address - City:FAIRFAX
Mailing Address - State:MO
Mailing Address - Zip Code:64446-9105
Mailing Address - Country:US
Mailing Address - Phone:660-686-2211
Mailing Address - Fax:660-686-2799
Practice Address - Street 1:26136 US HIGHWAY 59
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:MO
Practice Address - Zip Code:64446-8155
Practice Address - Country:US
Practice Address - Phone:660-686-2211
Practice Address - Fax:660-686-2618
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY HOSPITAL ASSOCIATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-03-14
Last Update Date:2014-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO345-13251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO580492502Medicaid
MO90307018OtherBCBS OF KANSAS CITY
1336118397Medicare NSC
MO90307018OtherBCBS OF KANSAS CITY