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General NPI Number Information
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NPI Number | 1053785436
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Entity Type | Organization
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Legal Business Name | COMMUNITY AWARENESS RESOURCE ENDEAVORS
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Dates
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Enumeration Date | 11/23/2015
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Last Update Date | 11/23/2015
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Provider Practice Location Address
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Address Line | 110 JOHNS CT
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City | FRONTENAC
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State | KS
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Zip | 66763-2176
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Country | US
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Telephone | 620-249-8292
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Fax |
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Provider Business Mailing Address
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Address Line | 110 JOHNS CT
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City | FRONTENAC
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State | KS
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Zip | 66763-2176
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Country | US
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Telephone | 620-249-8292
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | BRIAN VANDENBERG
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Credential | NP-BC
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Telephone | 620-249-8292
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 261QP0904X
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Taxonomy Name | Federal Public Health Clinic/Center
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License Number |
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License Number State | KS
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