Provider Demographics
NPI:1568484848
Name:COMMUNITY MEMORIAL HEALTHCARE, INC.
Entity Type:Organization
Organization Name:COMMUNITY MEMORIAL HEALTHCARE, INC.
Other - Org Name:COMMUNITY MEMORIAL HEALTHCARE HHA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ACCOUNTANT
Authorized Official - Prefix:
Authorized Official - First Name:THERESE
Authorized Official - Middle Name:M
Authorized Official - Last Name:LANDOLL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-562-4384
Mailing Address - Street 1:805 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:66508-1802
Mailing Address - Country:US
Mailing Address - Phone:785-562-4062
Mailing Address - Fax:785-629-8131
Practice Address - Street 1:805 BROADWAY
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:KS
Practice Address - Zip Code:66508-1802
Practice Address - Country:US
Practice Address - Phone:785-562-4062
Practice Address - Fax:785-629-8131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-24
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100005390FMedicaid
KS000588OtherBLUE CROSS/BLUE SHIELD KS
KS100269370AMedicaid
177101Medicare Oscar/Certification