Provider Demographics
NPI:1457531477
Name:CATHOLIC CHARITIES OF NORTHEAST KANSAS INC
Entity Type:Organization
Organization Name:CATHOLIC CHARITIES OF NORTHEAST KANSAS INC
Other - Org Name:CATHOLIC COMMUNITY SERVICES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-433-2102
Mailing Address - Street 1:2220 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66102-4759
Mailing Address - Country:US
Mailing Address - Phone:913-433-2102
Mailing Address - Fax:913-371-3080
Practice Address - Street 1:9740 W 87TH ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66212-4563
Practice Address - Country:US
Practice Address - Phone:913-433-2102
Practice Address - Fax:913-371-3080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-07
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
No251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS=========OtherMAIN ORGANIZATION