Healthcare Provider Details

I. General information

NPI: 1558554881
Provider Name (Legal Business Name): DJKIERL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2007
Last Update Date: 03/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

736 HEYLMAN ST
FORT SCOTT KS
66701-2433
US

IV. Provider business mailing address

214 S. 10TH ST
MOUND CITY KS
66056-5265
US

V. Phone/Fax

Practice location:
  • Phone: 620-223-3120
  • Fax: 620-223-1560
Mailing address:
  • Phone: 913-795-2637
  • Fax: 913-795-2637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3140N1450X
TaxonomyPediatric Skilled Nursing Facility
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. RAYMOND D. KIERL
Title or Position: PRESIDENT
Credential:
Phone: 913-795-2637