Provider Demographics
NPI:1811333081
Name:MENNONITE FRIENDSHIP COMMUNITIES, INC
Entity type:Organization
Organization Name:MENNONITE FRIENDSHIP COMMUNITIES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:LOWELL
Authorized Official - Middle Name:
Authorized Official - Last Name:PEACHEY
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:620-663-7175
Mailing Address - Street 1:600 W BLANCHARD AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH HUTCHINSON
Mailing Address - State:KS
Mailing Address - Zip Code:67505-1526
Mailing Address - Country:US
Mailing Address - Phone:620-663-7175
Mailing Address - Fax:620-663-4221
Practice Address - Street 1:600 W BLANCHARD AVE
Practice Address - Street 2:
Practice Address - City:SOUTH HUTCHINSON
Practice Address - State:KS
Practice Address - Zip Code:67505-1526
Practice Address - Country:US
Practice Address - Phone:620-663-7175
Practice Address - Fax:620-663-4221
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MENNONITE FRIENSHIP COMMUNITIES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-05-15
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSA-078-006251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSA-078-006Medicaid