Provider Demographics
NPI:1215107222
Name:CATHOLIC CARE CAMPUS, INC.
Entity type:Organization
Organization Name:CATHOLIC CARE CAMPUS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHESTER
Authorized Official - Middle Name:
Authorized Official - Last Name:SURMACZEWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-906-0990
Mailing Address - Street 1:13800 W 116TH ST.
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062
Mailing Address - Country:US
Mailing Address - Phone:913-906-0990
Mailing Address - Fax:913-906-0911
Practice Address - Street 1:13800 W 116TH ST
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-7833
Practice Address - Country:US
Practice Address - Phone:913-906-0990
Practice Address - Fax:913-906-0911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-05
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSN046075310400000X, 311500000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS175503Medicare Oscar/Certification