Provider Demographics
NPI:1578556569
Name:CONGREGATIONAL HOME
Entity Type:Organization
Organization Name:CONGREGATIONAL HOME
Other - Org Name:BREWSTER PLACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-274-3381
Mailing Address - Street 1:1205 SW 29TH ST
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66611-1203
Mailing Address - Country:US
Mailing Address - Phone:785-274-3350
Mailing Address - Fax:785-274-5782
Practice Address - Street 1:1205 SW 29TH ST
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66611-1203
Practice Address - Country:US
Practice Address - Phone:785-274-3350
Practice Address - Fax:785-274-5782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-25
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSN089001314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS389OtherBCBS
KS100107350AMedicaid
KS100107350BMedicaid
KS389OtherBCBS