Healthcare Provider Details

I. General information

NPI: 1063989432
Provider Name (Legal Business Name): RICE COUNTY ASSISTED LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2018
Last Update Date: 10/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 S MILES AVE
LYONS KS
67554-3008
US

IV. Provider business mailing address

714 W 9TH ST
LARNED KS
67550-2452
US

V. Phone/Fax

Practice location:
  • Phone: 620-257-5012
  • Fax: 620-257-5304
Mailing address:
  • Phone: 620-285-6900
  • Fax: 620-285-6907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LAURA THERESA SMITH
Title or Position: MANAGING MEMBER
Credential:
Phone: 622-285-6900