Healthcare Provider Details

I. General information

NPI: 1063473130
Provider Name (Legal Business Name): CENTERS FOR LONG TERM CARE OF GARDNER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

427 W MAIN ST
GARDNER KS
66030-1183
US

IV. Provider business mailing address

PO BOX 155635
FORT WORTH TX
76155-0635
US

V. Phone/Fax

Practice location:
  • Phone: 913-856-8747
  • Fax: 913-856-8339
Mailing address:
  • Phone: 817-359-2000
  • Fax: 817-359-2093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License Number
License Number State

VIII. Authorized Official

Name: GARY TREBERT
Title or Position: CEO
Credential:
Phone: 817-359-2000