1689699837 NPI number — CRAIG RESOURCES, INC

Table of content: (NPI 1689699837)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689699837 NPI number — CRAIG RESOURCES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CRAIG RESOURCES, INC
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:
CRAIG HOMECARE
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:
1689699837
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/26/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1220 E 1ST ST N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WICHITA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67214-3907
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
316-266-8717
Provider Business Mailing Address Fax Number:
316-266-8757

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1220 E 1ST ST N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WICHITA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67214-3907
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
316-266-8717
Provider Business Practice Location Address Fax Number:
316-266-8757
Provider Enumeration Date:
07/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BALKE
Authorized Official First Name:
SEAN
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
316-266-8722

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  A-085-010 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251E00000X , with the licence number: A-068-002 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X , with the licence number: A-089-031 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X , with the licence number: A-050-007 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X , with the licence number: HHA200609 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 385H00000X , with the licence number: A-089-031 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 385H00000X , with the licence number: A-050-007 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 385H00000X , with the licence number: A-087-046 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 385H00000X , with the licence number: A-085-010 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 385H00000X , with the licence number: A-068-002 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 100066570F , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100007090C , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100066570G , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10025453800 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 30003931500027 , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 30003931500005 , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100066570C , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100007090E , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 30003931500007 , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100007090A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100007090F , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 30003931500004 , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 300039315000013 , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 30003931500006 , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 945429900 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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