=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588350037
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMMUNITY CARE HOSPICE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/17/2023
-----------------------------------------------------
Last Update Date | 07/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 905 CEDARS DR
-----------------------------------------------------
City | MCPHERSON
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67460-2733
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 785-232-2044
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 200 SW FRAZIER CIR
-----------------------------------------------------
City | TOPEKA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66606-2800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 785-232-2044
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | SHAWN SULLIVAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 785-232-2044
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251G00000X
-----------------------------------------------------
Taxonomy Name | Community Based Hospice Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------