1346869088 NPI number — CENTRAL CARE, PA

Table of content: (NPI 1346869088)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346869088 NPI number — CENTRAL CARE, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRAL CARE, PA
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:
Provider Other Organization Name Type Code:
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:
1346869088
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/13/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2337 E CRAWFORD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALINA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67401-3713
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
785-823-0633
Provider Business Mailing Address Fax Number:
844-854-4662

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
305 W 15TH ST STE 203
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LIBERAL
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67901-2455
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-624-4700
Provider Business Practice Location Address Fax Number:
888-235-3625
Provider Enumeration Date:
04/13/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CLOYD
Authorized Official First Name:
STACY
Authorized Official Middle Name:
Authorized Official Title or Position:
PROVIDER ENROLLMENT SPECIALIST
Authorized Official Telephone Number:
785-823-0633

Provider Taxonomy Codes

  • Taxonomy code: 332900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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