Provider Demographics
NPI:1275542862
Name:CATHOLIC COMMUNITY HOSPICE OF NORTHEAST KANSAS, INC.
Entity Type:Organization
Organization Name:CATHOLIC COMMUNITY HOSPICE OF NORTHEAST KANSAS, INC.
Other - Org Name:CATHOLIC COMMUNITY HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RODENY
Authorized Official - Middle Name:E
Authorized Official - Last Name:WHITTINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-433-2029
Mailing Address - Street 1:16201 W 95TH ST STE 220
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66219-1217
Mailing Address - Country:US
Mailing Address - Phone:913-621-5090
Mailing Address - Fax:913-371-3080
Practice Address - Street 1:3210 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64109-3102
Practice Address - Country:US
Practice Address - Phone:816-523-5634
Practice Address - Fax:913-371-3080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO106-23HO251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO824949507Medicaid
MO261644Medicare Oscar/Certification