Provider Demographics
NPI:1639591621
Name:CASEMANAGER FOR INDEPENCE
Entity Type:Organization
Organization Name:CASEMANAGER FOR INDEPENCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INDEPENDENT LIVING COUSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CANDY
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:GERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:ILC
Authorized Official - Phone:620-659-5147
Mailing Address - Street 1:406 MASSACHUSETTS AVE
Mailing Address - Street 2:
Mailing Address - City:KINSLEY
Mailing Address - State:KS
Mailing Address - Zip Code:67547-1055
Mailing Address - Country:US
Mailing Address - Phone:620-659-5147
Mailing Address - Fax:
Practice Address - Street 1:406 MASSACHUSETTS AVE
Practice Address - Street 2:
Practice Address - City:KINSLEY
Practice Address - State:KS
Practice Address - Zip Code:67547-1055
Practice Address - Country:US
Practice Address - Phone:620-659-5147
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-10
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200750150AMedicaid