Healthcare Provider Details

I. General information

NPI: 1508804998
Provider Name (Legal Business Name): SENIORTRUST OF COUNCIL GROVE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 SUNSET DR
COUNCIL GROVE KS
66846-1554
US

IV. Provider business mailing address

400 SUNSET DR
COUNCIL GROVE KS
66846-1554
US

V. Phone/Fax

Practice location:
  • Phone: 620-767-5172
  • Fax:
Mailing address:
  • Phone: 620-767-5172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberN064001
License Number StateKS

VIII. Authorized Official

Name: ROBERT WEBB
Title or Position: PRESIDENT
Credential:
Phone: 615-893-2749