Healthcare Provider Details

I. General information

NPI: 1053785436
Provider Name (Legal Business Name): COMMUNITY AWARENESS RESOURCE ENDEAVORS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2015
Last Update Date: 11/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 JOHNS CT
FRONTENAC KS
66763-2176
US

IV. Provider business mailing address

110 JOHNS CT
FRONTENAC KS
66763-2176
US

V. Phone/Fax

Practice location:
  • Phone: 620-249-8292
  • Fax:
Mailing address:
  • Phone: 620-249-8292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP0904X
TaxonomyFederal Public Health Clinic/Center
License Number
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number StateKS

VIII. Authorized Official

Name: BRIAN VANDENBERG
Title or Position: DIRECTOR
Credential: NP-BC
Phone: 620-249-8292