MEDICARE: GOD'S CHOSEN SENIOR CARE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1326738212
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOD'S CHOSEN SENIOR CARE, LLC

Provider Business Mailing Address
First Line	:	10921 W ROLLINGHILLS DR
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67212
Country	:	US
Telephone Number	:	316-390-6971
Fax Number	:

Provider Business Practice Location Address
First Line	:	2734 N WELLESLEY ST
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67220
Country	:	US
Telephone Number	:	833-379-1954
Fax Number	:

Authorized Official
Title or Position	:	OPERATOR
Name	:	VALGEAN ROSEBOROUGH
Credential	:
Telephone Number	:	316-390-6971

Provider Enumeration Date	:	05/12/2023
Last Update Date	:	05/12/2023

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