Provider Demographics
NPI:1881054005
Name:BLUESTEM PACE
Entity type:Organization
Organization Name:BLUESTEM PACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-504-5950
Mailing Address - Street 1:3001 IVY DR
Mailing Address - Street 2:
Mailing Address - City:NORTH NEWTON
Mailing Address - State:KS
Mailing Address - Zip Code:67117-8001
Mailing Address - Country:US
Mailing Address - Phone:316-836-4800
Mailing Address - Fax:316-836-4250
Practice Address - Street 1:113 S ASH ST
Practice Address - Street 2:
Practice Address - City:MCPHERSON
Practice Address - State:KS
Practice Address - Zip Code:67460-4801
Practice Address - Country:US
Practice Address - Phone:620-504-5900
Practice Address - Fax:620-504-5674
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BLUESTEM COMMUNITIES INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-03-01
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSH9438251T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSH9438OtherPACE PLAN