Healthcare Provider Details

I. General information

NPI: 1720086416
Provider Name (Legal Business Name): QUAKER HILL NURSING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 01/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8675 SE 72ND TER
BAXTER SPRINGS KS
66713-3186
US

IV. Provider business mailing address

8675 SE 72ND TER
BAXTER SPRINGS KS
66713-3186
US

V. Phone/Fax

Practice location:
  • Phone: 620-848-3797
  • Fax: 620-878-3017
Mailing address:
  • Phone: 620-848-3797
  • Fax: 620-878-3017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberN011006
License Number StateKS

VIII. Authorized Official

Name: MR. JAMES REIKER
Title or Position: TREASURER
Credential:
Phone: 573-471-1113