Organization
FOUR COUNTY MENTAL HEALTH CENTER, INC.
Active
Other names
Active Partners Home Health Care
Organization subpart
No
Provider details
NPI number
Authorized official
JODI HAYSE (DIRECTOR OF BUSINESS OPERATIONS)
(620) 331-1748
Entity
Organization
Contact information
Practice address
415 FRUITLAND AVE, INDEPENDENCE, KS 67301-8592
(620) 332-8586
Mailing address
PO BOX 688, INDEPENDENCE, KS 67301-0688
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
A-103003
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100097980Y
—
KS
01
—
17-7176
MEDICARE PTAN
—
Enumeration date
07/14/2010
Last updated
01/31/2013
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