Healthcare Provider Details

I. General information

NPI: 1437934221
Provider Name (Legal Business Name): HIAWATHA OPCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2023
Last Update Date: 08/29/2023
Certification Date: 08/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 E IOWA ST
HIAWATHA KS
66434-9826
US

IV. Provider business mailing address

314 NW 11TH ST
BLUE SPRINGS MO
64015-3676
US

V. Phone/Fax

Practice location:
  • Phone: 785-742-7465
  • Fax:
Mailing address:
  • Phone: 816-622-1017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: ADAM CONDER
Title or Position: GENERAL COUNSEL
Credential:
Phone: 816-622-1017