Provider Demographics
NPI:1992855852
Name:SOUTHEAST KANSAS INDEPENDENT LIVING RESOURCE CENTER, INC.
Entity Type:Organization
Organization Name:SOUTHEAST KANSAS INDEPENDENT LIVING RESOURCE CENTER, INC.
Other - Org Name:INDEPENDENT STRIDES HOME HEALTH AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TARINA
Authorized Official - Middle Name:
Authorized Official - Last Name:LANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-423-3328
Mailing Address - Street 1:PO BOX 259
Mailing Address - Street 2:
Mailing Address - City:PARSONS
Mailing Address - State:KS
Mailing Address - Zip Code:67357-0259
Mailing Address - Country:US
Mailing Address - Phone:620-423-3328
Mailing Address - Fax:
Practice Address - Street 1:1712 MAIN ST
Practice Address - Street 2:
Practice Address - City:PARSONS
Practice Address - State:KS
Practice Address - Zip Code:67357-3339
Practice Address - Country:US
Practice Address - Phone:620-423-3328
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSA050009251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100021850 EMedicaid
KS100021850 EMedicaid