Healthcare Provider Details

I. General information

NPI: 1508848482
Provider Name (Legal Business Name): LOUISBURG HEALTHCARE AND REHABILITATION CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 02/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 S. BROADWAY ST.
LOUISBURG KS
66053-3607
US

IV. Provider business mailing address

1200 S. BROADWAY ST.
LOUISBURG KS
66053-3607
US

V. Phone/Fax

Practice location:
  • Phone: 913-837-2916
  • Fax: 913-837-5782
Mailing address:
  • Phone: 913-837-2916
  • Fax: 913-837-5782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberN061006
License Number StateKS

VIII. Authorized Official

Name: MICHAEL T. BERG
Title or Position: ASSISTANT SECRETARY
Credential:
Phone: 505-468-4752