Healthcare Provider Details

I. General information

NPI: 1093975534
Provider Name (Legal Business Name): CDDO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2008
Last Update Date: 06/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

528 N STEVENSON ST
OLATHE KS
66061-3333
US

IV. Provider business mailing address

528 N STEVENSON ST
OLATHE KS
66061-3333
US

V. Phone/Fax

Practice location:
  • Phone: 913-782-2737
  • Fax:
Mailing address:
  • Phone: 913-782-2737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: PEGGY SHEAR
Title or Position: CDDO DIRECTOR
Credential:
Phone: 913-826-2511