Healthcare Provider Details

I. General information

NPI: 1225116684
Provider Name (Legal Business Name): MEDICALODGES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 06/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 LIBERTY ST
CLAY CENTER KS
67432-1528
US

IV. Provider business mailing address

715 LIBERTY ST
CLAY CENTER KS
67432-1528
US

V. Phone/Fax

Practice location:
  • Phone: 785-632-5696
  • Fax: 785-632-2855
Mailing address:
  • Phone: 785-632-5696
  • Fax: 785-632-2855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License NumberN104004
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberN104004
License Number StateKS

VIII. Authorized Official

Name: MS. CATHY W FISHER
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 620-251-6700