Healthcare Provider Details

I. General information

NPI: 1073624607
Provider Name (Legal Business Name): COUNTY OF REPUBLIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 08/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2316 G ST
BELLEVILLE KS
66935-2452
US

IV. Provider business mailing address

2316 G ST
BELLEVILLE KS
66935-2452
US

V. Phone/Fax

Practice location:
  • Phone: 785-527-5671
  • Fax: 785-527-2892
Mailing address:
  • Phone: 785-527-5671
  • Fax: 785-527-2892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberA-079-001
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License NumberN/A
License Number State

VIII. Authorized Official

Name: DANIELLE SWANSON
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 785-527-5671