MEDICARE: QUAKER HILL NURSING, 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	314000000X	Skilled Nursing Facility	N011006	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720086416
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QUAKER HILL NURSING, LLC

Provider Business Mailing Address
First Line	:	8675 SE 72ND TER
Second Line	:
City	:	BAXTER SPRINGS
State	:	KS
Zip	:	66713-3186
Country	:	US
Telephone Number	:	620-848-3797
Fax Number	:	620-878-3017

Provider Business Practice Location Address
First Line	:	8675 SE 72ND TER
Second Line	:
City	:	BAXTER SPRINGS
State	:	KS
Zip	:	66713-3186
Country	:	US
Telephone Number	:	620-848-3797
Fax Number	:	620-878-3017

Authorized Official
Title or Position	:	TREASURER
Name	:	MR. JAMES REIKER
Credential	:
Telephone Number	:	573-471-1113

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	01/29/2013

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