Healthcare Provider Details

I. General information

NPI: 1043236433
Provider Name (Legal Business Name): COMMUNITY MEMORIAL HEALTHCARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 10/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

708 N 18TH ST
MARYSVILLE KS
66508-1338
US

IV. Provider business mailing address

708 N 18TH ST
MARYSVILLE KS
66508-1338
US

V. Phone/Fax

Practice location:
  • Phone: 785-562-2311
  • Fax: 785-562-2348
Mailing address:
  • Phone: 785-562-2311
  • Fax: 785-562-2348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: THERESE M LANDOLL
Title or Position: CFO
Credential:
Phone: 785-562-2311