Healthcare Provider Details

I. General information

NPI: 1770536559
Provider Name (Legal Business Name): AMBERWELL ATCHISON ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 11/15/2024
Certification Date: 11/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 COMMERCIAL ST
ATCHISON KS
66002-2434
US

IV. Provider business mailing address

800 RAVENHILL DR
ATCHISON KS
66002-9204
US

V. Phone/Fax

Practice location:
  • Phone: 913-360-5520
  • Fax: 913-367-2913
Mailing address:
  • Phone: 913-367-2131
  • Fax: 913-367-2913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberKSA-003-001
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberKSA003001
License Number StateKS

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JARED ABEL
Title or Position: CEO
Credential:
Phone: 913-367-2131