Provider Demographics
NPI:1588645246
Name:ST. JOHN HOSPITAL HOME HEALTH
Entity Type:Organization
Organization Name:ST. JOHN HOSPITAL HOME HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SMART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-680-6300
Mailing Address - Street 1:3500 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:LEAVENWORTH
Mailing Address - State:KS
Mailing Address - Zip Code:66048-5043
Mailing Address - Country:US
Mailing Address - Phone:913-680-6300
Mailing Address - Fax:913-680-6309
Practice Address - Street 1:3500 S 4TH ST
Practice Address - Street 2:
Practice Address - City:LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66048-5043
Practice Address - Country:US
Practice Address - Phone:913-680-6300
Practice Address - Fax:913-680-6309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSA-052-003251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO90250011OtherBLUE CROSS/BLUE SHIELD
KS0000000686OtherBLUE CROSS/BLUE SHIELD
KS177156Medicare ID - Type Unspecified