Healthcare Provider Details

I. General information

NPI: 1336263557
Provider Name (Legal Business Name): ELLINWOOD SENIOR LIVING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 06/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 N MAIN ST
ELLINWOOD KS
67526-1657
US

IV. Provider business mailing address

302 N MAIN ST
ELLINWOOD KS
67526-1657
US

V. Phone/Fax

Practice location:
  • Phone: 620-564-2100
  • Fax: 620-564-3200
Mailing address:
  • Phone: 620-564-2100
  • Fax: 620-564-3200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberB00-5001
License Number StateKS

VIII. Authorized Official

Name: MRS. MISSY DAWN PFLUGHOEFT
Title or Position: OPERATOR
Credential:
Phone: 620-564-2100