Provider Demographics
NPI:1104969468
Name:SENECA HEALTHCARE GROUP INC.
Entity type:Organization
Organization Name:SENECA HEALTHCARE GROUP INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CLARICE
Authorized Official - Middle Name:J
Authorized Official - Last Name:POWERS
Authorized Official - Suffix:
Authorized Official - Credentials:RN, PHD
Authorized Official - Phone:316-267-4663
Mailing Address - Street 1:8415 E 32ND ST N
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-2607
Mailing Address - Country:US
Mailing Address - Phone:316-267-4663
Mailing Address - Fax:316-522-2551
Practice Address - Street 1:8415 E 32ND ST N
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-2607
Practice Address - Country:US
Practice Address - Phone:316-267-4663
Practice Address - Fax:316-522-2551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS200374750B251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200374750BMedicaid