Healthcare Provider Details

I. General information

NPI: 1639454044
Provider Name (Legal Business Name): SENIOR HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2011
Last Update Date: 10/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2921 W 1ST ST
COFFEYVILLE KS
67337-2441
US

IV. Provider business mailing address

302 SOUTHERN HILLS DR
COFFEYVILLE KS
67337-9623
US

V. Phone/Fax

Practice location:
  • Phone: 620-251-5190
  • Fax:
Mailing address:
  • Phone: 316-992-1591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SG0600X
TaxonomyGerontology Clinical Nurse Specialist
License Number74308
License Number StateKS

VIII. Authorized Official

Name: DANA E MORTON
Title or Position: ARNP
Credential:
Phone: 316-992-1591