Provider Demographics
NPI:1821063249
Name:COMMUNITY HEALTHCARE SYSTEM, INC
Entity Type:Organization
Organization Name:COMMUNITY HEALTHCARE SYSTEM, INC
Other - Org Name:EASTRIDGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:M
Authorized Official - Last Name:WILLERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-889-5002
Mailing Address - Street 1:604 1ST ST
Mailing Address - Street 2:
Mailing Address - City:CENTRALIA
Mailing Address - State:KS
Mailing Address - Zip Code:66415-9637
Mailing Address - Country:US
Mailing Address - Phone:785-857-3388
Mailing Address - Fax:785-857-3349
Practice Address - Street 1:604 1ST ST
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:KS
Practice Address - Zip Code:66415-9637
Practice Address - Country:US
Practice Address - Phone:785-857-3388
Practice Address - Fax:785-857-3349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-20
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSN066006261QA0600X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS001247OtherBLUE CROSS BLUE SHIELD
KS100111800AMedicaid
KS175374Medicare Oscar/Certification