Provider Demographics
NPI:1689000853
Name:CASE MANAGEMENT BY KRIS LLC
Entity type:Organization
Organization Name:CASE MANAGEMENT BY KRIS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CASE MANAGER - TCM
Authorized Official - Prefix:
Authorized Official - First Name:KRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:LUNDGREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-271-2492
Mailing Address - Street 1:PO BOX 295
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67846-0295
Mailing Address - Country:US
Mailing Address - Phone:620-271-2492
Mailing Address - Fax:
Practice Address - Street 1:561 S LOVERS LN
Practice Address - Street 2:
Practice Address - City:SCOTT CITY
Practice Address - State:KS
Practice Address - Zip Code:67871-5029
Practice Address - Country:US
Practice Address - Phone:620-271-2492
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-19
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS100374970A251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100374970AMedicaid