Healthcare Provider Details

I. General information

NPI: 1619185345
Provider Name (Legal Business Name): JEWELL HEALTH CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

272 W CHEYENNE ST
HOISINGTON KS
67544-1576
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 620-653-4141
  • Fax: 620-653-4282
Mailing address:
  • Phone: 816-322-8113
  • Fax: 816-322-6671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3140N1450X
TaxonomyPediatric Skilled Nursing Facility
License NumberN005003
License Number StateKS

VIII. Authorized Official

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