Provider Demographics
NPI:1528756590
Name:KANSAS CARE CONNECT, LLC
Entity type:Organization
Organization Name:KANSAS CARE CONNECT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RACHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERO
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:316-210-6890
Mailing Address - Street 1:1010 N WOODRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-4109
Mailing Address - Country:US
Mailing Address - Phone:316-370-2406
Mailing Address - Fax:316-803-1462
Practice Address - Street 1:7111 E 21ST ST N STE 104
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-1090
Practice Address - Country:US
Practice Address - Phone:316-370-2406
Practice Address - Fax:316-803-1462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-27
Last Update Date:2023-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service