Provider Demographics
NPI:1689192437
Name:TOPEKA HOUSING AUTHORITY
Entity Type:Organization
Organization Name:TOPEKA HOUSING AUTHORITY
Other - Org Name:PINE RIDGE FAMILY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HEALTH SERVICES ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SODAMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-783-8453
Mailing Address - Street 1:2721 SE 10TH ST
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66607-1706
Mailing Address - Country:US
Mailing Address - Phone:785-783-8453
Mailing Address - Fax:785-783-8469
Practice Address - Street 1:2721 SE 10TH ST
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66607-1706
Practice Address - Country:US
Practice Address - Phone:785-357-8842
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TOPEKA HOUSING AUTHORITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-08-31
Last Update Date:2017-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-46075363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200964710BMedicaid