Healthcare Provider Details

I. General information

NPI: 1083133458
Provider Name (Legal Business Name): KANSAS SENIOR LIVING INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2017
Last Update Date: 09/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 W BEESON RD
DODGE CITY KS
67801-5915
US

IV. Provider business mailing address

6025 SW 39TH CT
TOPEKA KS
66610-1372
US

V. Phone/Fax

Practice location:
  • Phone: 620-227-7512
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: JOHN RICHARD GRACE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 785-506-6003