Provider Demographics
NPI:1972563641
Name:JOHNSON COUNTY COMMUNITY HEALTH SERVICES
Entity type:Organization
Organization Name:JOHNSON COUNTY COMMUNITY HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:K
Authorized Official - Last Name:HALLER
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:660-747-6121
Mailing Address - Street 1:723 PCA RD
Mailing Address - Street 2:
Mailing Address - City:WARRENSBURG
Mailing Address - State:MO
Mailing Address - Zip Code:64093-7913
Mailing Address - Country:US
Mailing Address - Phone:660-747-6121
Mailing Address - Fax:660-747-6087
Practice Address - Street 1:723 PCA RD
Practice Address - Street 2:
Practice Address - City:WARRENSBURG
Practice Address - State:MO
Practice Address - Zip Code:64093-7913
Practice Address - Country:US
Practice Address - Phone:660-747-6121
Practice Address - Fax:660-747-6087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-25
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO510621907Medicaid
MD9004000Medicare Oscar/Certification