Provider Demographics
NPI:1790057388
Name:ST JOHN'S CATHOLIC CHURCH
Entity Type:Organization
Organization Name:ST JOHN'S CATHOLIC CHURCH
Other - Org Name:CENTRO HISPANO RSOURCE CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:DENNING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-843-0109
Mailing Address - Street 1:1229 VERMONT ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044-3233
Mailing Address - Country:US
Mailing Address - Phone:785-843-0109
Mailing Address - Fax:785-749-5064
Practice Address - Street 1:204 W 13TH ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044-3404
Practice Address - Country:US
Practice Address - Phone:785-843-2039
Practice Address - Fax:795-749-5064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-30
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS7640104100000X
KS7643104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1164703055Medicaid
KS200626190AMedicaid