Iroquois Center for Human Development, Inc.
Organization Active NPI Mental Health Clinic/Center (Including Community Mental Health Center) · Greensburg, KS
NPI 1922001981 · NPPES record last updated Aug 22, 2020
Key facts
- NPI
- 1922001981
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X
- Legal business name
- IROQUOIS CENTER FOR HUMAN DEVELOPMENT, INC.
- Practice address
- 610 E Grant Ave
Greensburg, KS 67054-2708 - Phone
- (620) 723-2272
- Fax
- (620) 723-3450
- NPI assigned
- May 24, 2005
- Organization subpart
- No
Authorized official
- Name
- Mr. Charles Sheldon Carpenter, LMLP, LCP
- Title
- Executive Director
- Phone
- (620) 723-2272
Corporate family (same tax ID) 1
Practitioners 14
-
Julia Butler, LCPC
-
Tracy Jo Caldwell, RN, APRN
-
Angela D Kooken, LMSW
-
Kurt D Leis, ARNP
-
Aaron Pendergrass, LSCSW
-
Scott G Rogers, LMLP, LCP
-
Charles Lucas Stephens, LMLP, LCP
-
Stephanie J Salisbury, LSCSW
-
Cheryl R Gore, APRN
-
Stephen Ross O'Neill, LSCSW, LCSW
-
Heath J. Vandeventer, LCP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KS
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040915000321 | KS | Part B Supplier - Clinic/Group Practice | 2062314081 |
Receives reassigned benefits from 14 practitioners Practice locations: Greensburg, KS |
National Provider Directory
- Tax ID family
- Iroquois Center for Human Development Inc
Locations
610 E Grant Ave
Greensburg, KS 67054
Phone (620) 723-2272
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Clinic/Center (Including Community Mental Health Center) | 261QM0801X | Yes |
Addresses
Primary practice location
610 E Grant Ave
Greensburg, KS 67054-2708
Mailing address
610 E Grant Ave
Greensburg, KS 67054-2708
Phone (620) 723-2272
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100098110B | Medicaid | KS | |
| 100098110A | Medicaid | KS |
Other providers in Greensburg, KS
- Travis Keith Hamrick
- Kelsey Renee Hott
- Hunter Drug
- Iroquois Center for Human Development, Inc.
- Iroquois Center for Human Development, Inc.
- Kansas Assisted Living LLC
- Julie Keeton
- Micah Cole Kendall
- Kiowa County Memorial Hospital
- Kiowa County Memorial Hospital
All providers in Greensburg, KS · Mental Health Clinic/Center (Including Community Mental Health Center) in Kansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.