Provider Demographics
NPI:1568862332
Name:MULTI COMMUNITY DIVERSIFIED SERVICES, INC.
Entity Type:Organization
Organization Name:MULTI COMMUNITY DIVERSIFIED SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUG
Authorized Official - Middle Name:
Authorized Official - Last Name:WISBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-241-6693
Mailing Address - Street 1:2107 INDUSTRIAL DR
Mailing Address - Street 2:
Mailing Address - City:MCPHERSON
Mailing Address - State:KS
Mailing Address - Zip Code:67460-8128
Mailing Address - Country:US
Mailing Address - Phone:620-241-6693
Mailing Address - Fax:620-241-6699
Practice Address - Street 1:2107 INDUSTRIAL DR
Practice Address - Street 2:
Practice Address - City:MCPHERSON
Practice Address - State:KS
Practice Address - Zip Code:67460-8128
Practice Address - Country:US
Practice Address - Phone:620-241-6693
Practice Address - Fax:620-241-6699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-29
Last Update Date:2014-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100044250BMedicaid