Provider Demographics
NPI:1659348589
Name:COMMUNITY MEMORIAL HEALTHCARE, INC.
Entity Type:Organization
Organization Name:COMMUNITY MEMORIAL HEALTHCARE, INC.
Other - Org Name:COMMUNITY MEMORIAL HEALTHCARE SWING BED
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
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:785-562-2311
Mailing Address - Street 1:708 N 18TH ST
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:66508-1338
Mailing Address - Country:US
Mailing Address - Phone:785-562-2311
Mailing Address - Fax:785-562-2348
Practice Address - Street 1:708 N 18TH ST
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:KS
Practice Address - Zip Code:66508-1338
Practice Address - Country:US
Practice Address - Phone:785-562-2311
Practice Address - Fax:785-562-2348
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY MEMORIAL HEALTHCARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-02-28
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSH058001275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS001152OtherBLUE CROSS
KS001152OtherBLUE CROSS