Healthcare Provider Details

I. General information

NPI: 1952357808
Provider Name (Legal Business Name): COUNTY OF CLOUD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 01/25/2024
Certification Date: 01/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 W. 11TH STREET
CONCORDIA KS
66901-3905
US

IV. Provider business mailing address

910 W. 11TH STREET
CONCORDIA KS
66901
US

V. Phone/Fax

Practice location:
  • Phone: 785-243-8140
  • Fax: 785-243-8149
Mailing address:
  • Phone: 785-243-8140
  • Fax: 785-243-8149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberK.S.A. 65-5101
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License NumberK.S.A. 65-5101
License Number StateKS

VIII. Authorized Official

Name: TONYA LYNN SULANKA
Title or Position: ADMINISTRATOR
Credential:
Phone: 785-243-8140