Provider Demographics
NPI:1922001981
Name:IROQUOIS CENTER FOR HUMAN DEVELOPMENT, INC.
Entity Type:Organization
Organization Name:IROQUOIS CENTER FOR HUMAN DEVELOPMENT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:SHELDON
Authorized Official - Last Name:CARPENTER
Authorized Official - Suffix:
Authorized Official - Credentials:LMLP, LCP
Authorized Official - Phone:620-723-2272
Mailing Address - Street 1:610 E GRANT AVE
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:KS
Mailing Address - Zip Code:67054-2708
Mailing Address - Country:US
Mailing Address - Phone:620-723-2272
Mailing Address - Fax:620-723-3450
Practice Address - Street 1:610 E GRANT AVE
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:KS
Practice Address - Zip Code:67054-2708
Practice Address - Country:US
Practice Address - Phone:620-723-2272
Practice Address - Fax:620-723-3450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100098110BMedicaid
KS100098110AMedicaid