Provider Demographics
NPI:1396842662
Name:CITY OF LOGAN
Entity Type:Organization
Organization Name:CITY OF LOGAN
Other - Org Name:LOGAN MNAOR COMMUNITY HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MCCOMB
Authorized Official - Suffix:
Authorized Official - Credentials:ADM
Authorized Official - Phone:785-689-4201
Mailing Address - Street 1:108 S. ADAMS ST.
Mailing Address - Street 2:PO BOX 308
Mailing Address - City:LOGAN
Mailing Address - State:KS
Mailing Address - Zip Code:67646
Mailing Address - Country:US
Mailing Address - Phone:785-689-4201
Mailing Address - Fax:785-689-7411
Practice Address - Street 1:108 S ADAMS ST
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:KS
Practice Address - Zip Code:67646-5115
Practice Address - Country:US
Practice Address - Phone:785-689-4201
Practice Address - Fax:785-689-7411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSN074003251E00000X
KSN074001310400000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No251E00000XAgenciesHome Health
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSA-074-005OtherSTATE OF KANSAS HOME HEALTH AGENCY
KS100109100AMedicaid
KS014001OtherOCCUPATIONAL THERAPIST
KS100071510BMedicaid
KS115675OtherPHYSICAL THERAPIST
KS140915OtherPHYSICAL THERAPIST
KS000862OtherHOME HEALTH AGENCY
KS100109100BMedicaid
KS140915OtherPHYSICAL THERAPIST
KS014001OtherOCCUPATIONAL THERAPIST