Provider Demographics
NPI:1346651858
Name:CRAIG RESOURCES LLC
Entity type:Organization
Organization Name:CRAIG RESOURCES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REVENUE CYCLE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LEOLA
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:BOGARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-266-8717
Mailing Address - Street 1:1220 E 1ST ST N
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67214-3907
Mailing Address - Country:US
Mailing Address - Phone:316-266-8717
Mailing Address - Fax:316-266-8757
Practice Address - Street 1:2201 CENTRAL AVE STE A
Practice Address - Street 2:
Practice Address - City:DODGE CITY
Practice Address - State:KS
Practice Address - Zip Code:67801-6201
Practice Address - Country:US
Practice Address - Phone:785-798-4821
Practice Address - Fax:785-798-4823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-19
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSA-068-002251E00000X
251J00000X, 385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS30003931500003Medicaid
KS10000709MMedicaid