Provider Demographics
NPI:1245949684
Name:CORTERRA OF WICHITA, LLC
Entity type:Organization
Organization Name:CORTERRA OF WICHITA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/CHAIRMAN
Authorized Official - Prefix:
Authorized Official - First Name:ERIK
Authorized Official - Middle Name:
Authorized Official - Last Name:HATTEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-640-8427
Mailing Address - Street 1:7447 W VILLAGE CIR
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67205
Mailing Address - Country:US
Mailing Address - Phone:316-637-2889
Mailing Address - Fax:316-368-3177
Practice Address - Street 1:7447 W VILLAGE CIR
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67205
Practice Address - Country:US
Practice Address - Phone:316-637-2889
Practice Address - Fax:316-368-3177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-15
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS30005101960001Medicaid