Provider Demographics
NPI:1356170906
Name:CENTRAL CARE PLUS
Entity type:Organization
Organization Name:CENTRAL CARE PLUS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROLEX
Authorized Official - Middle Name:K
Authorized Official - Last Name:MUDIBO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-847-3170
Mailing Address - Street 1:5112 E CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-4110
Mailing Address - Country:US
Mailing Address - Phone:316-371-5355
Mailing Address - Fax:
Practice Address - Street 1:629 S LONGFELLOW ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67207-2368
Practice Address - Country:US
Practice Address - Phone:316-847-3170
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-31
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities