Healthcare Provider Details

I. General information

NPI: 1386853794
Provider Name (Legal Business Name): JEWEL HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 W LOGAN AVE
EMPORIA KS
66801-4661
US

IV. Provider business mailing address

12120 STATE LINE RD # 372
LEAWOOD KS
66209-1254
US

V. Phone/Fax

Practice location:
  • Phone: 620-342-4212
  • Fax: 620-342-6523
Mailing address:
  • Phone: 816-322-8113
  • Fax: 816-322-6671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberN056002
License Number StateKS

VIII. Authorized Official

Name: MR. JOHN LARSON
Title or Position: REGISTERED AGENT
Credential: ATTORNEY
Phone: 816-322-8113