Provider Demographics
NPI:1992144901
Name:ELIZABETH EASTES
Entity type:Organization
Organization Name:ELIZABETH EASTES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:EASTES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-259-6611
Mailing Address - Street 1:425 SANTA FE ST
Mailing Address - Street 2:
Mailing Address - City:HALSTEAD
Mailing Address - State:KS
Mailing Address - Zip Code:67056-2131
Mailing Address - Country:US
Mailing Address - Phone:316-259-6611
Mailing Address - Fax:
Practice Address - Street 1:425 SANTA FE ST
Practice Address - Street 2:
Practice Address - City:HALSTEAD
Practice Address - State:KS
Practice Address - Zip Code:67056-2131
Practice Address - Country:US
Practice Address - Phone:316-259-6611
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-24
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200739110AMedicaid