Healthcare Provider Details

I. General information

NPI: 1366082760
Provider Name (Legal Business Name): CRITTENDON HOME CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2020
Last Update Date: 01/14/2020
Certification Date: 01/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

824 COMMERCIAL ST
ATCHISON KS
66002-2325
US

IV. Provider business mailing address

824 COMMERCIAL ST
ATCHISON KS
66002-2325
US

V. Phone/Fax

Practice location:
  • Phone: 913-303-2400
  • Fax: 913-273-0284
Mailing address:
  • Phone: 913-303-2400
  • Fax: 913-273-0284

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: KERRI CRITTENDON
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 913-303-2400