Healthcare Provider Details

I. General information

NPI: 1013098367
Provider Name (Legal Business Name): CATHOLIC COMMUNITY SERVICE IN-HOME SUPPORT OF NORTHEAST KANSAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 05/01/2024
Certification Date: 05/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16201 W 95TH ST STE 220
LENEXA KS
66219-1217
US

IV. Provider business mailing address

16201 W 95TH ST STE 220
LENEXA KS
66219-1217
US

V. Phone/Fax

Practice location:
  • Phone: 913-433-2000
  • Fax: 913-371-3080
Mailing address:
  • Phone: 913-433-2000
  • Fax: 913-371-3080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License NumberA-105-013
License Number StateKS
# 3
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License NumberA-105-013
License Number StateKS

VIII. Authorized Official

Name: MRS. NICOLE ANTHONY
Title or Position: CFO
Credential:
Phone: 913-621-5090