1194025239 NPI number — CROSSROADS HOSPICE OF KANSAS LLC

Table of content: (NPI 1194025239)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194025239 NPI number — CROSSROADS HOSPICE OF KANSAS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CROSSROADS HOSPICE OF KANSAS LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CROSSROADS HOSPICE OF KANSAS, LLC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194025239
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/14/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10810 E 45TH ST STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TULSA
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74146-3816
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-627-6846
Provider Business Mailing Address Fax Number:
918-627-6856

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11150 THOMPSON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LENEXA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66219-2301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-850-7500
Provider Business Practice Location Address Fax Number:
913-850-7598
Provider Enumeration Date:
10/22/2010

Additional Information

Authorized Official

Authorized Official Last Name:
FARMER
Authorized Official First Name:
CLAYTON
Authorized Official Middle Name:
LEE
Authorized Official Title or Position:
CFO/COO
Authorized Official Telephone Number:
918-627-6846

Provider Taxonomy Codes

  • Taxonomy code: 207QH0002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251G00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 20070540A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".




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