Healthcare Provider Details

I. General information

NPI: 1073941845
Provider Name (Legal Business Name): SCHOENBERGER NURSING AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2013
Last Update Date: 10/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 W 10TH ST
ELLIS KS
67637-1624
US

IV. Provider business mailing address

106 W. 10TH
ELLIS KS
67637-1624
US

V. Phone/Fax

Practice location:
  • Phone: 785-726-3568
  • Fax: 785-726-3841
Mailing address:
  • Phone: 785-726-3568
  • Fax: 785-726-3841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number1350566122
License Number StateKS

VIII. Authorized Official

Name: EDITH MARLENE SCHOENBERGER
Title or Position: RN/ADMINISTRATOR
Credential: R.N.
Phone: 785-726-3568