Provider Demographics
NPI:1811901192
Name:COUNTY OF OTTAWA
Entity type:Organization
Organization Name:COUNTY OF OTTAWA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:K
Authorized Official - Last Name:CLINE
Authorized Official - Suffix:
Authorized Official - Credentials:RN BS
Authorized Official - Phone:785-392-2822
Mailing Address - Street 1:817A ARGYLE AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:KS
Mailing Address - Zip Code:67467-1621
Mailing Address - Country:US
Mailing Address - Phone:785-392-2822
Mailing Address - Fax:785-392-3640
Practice Address - Street 1:817A ARGYLE AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:KS
Practice Address - Zip Code:67467-1621
Practice Address - Country:US
Practice Address - Phone:785-392-2822
Practice Address - Fax:785-392-3640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSNO NUMBER251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100089240DMedicaid
KS119951OtherBLUE CROSS BLUE SHIELD
KS100089240DMedicaid