Healthcare Provider Details

I. General information

NPI: 1912067695
Provider Name (Legal Business Name): STONEYBROOK NURSING FACILITY OPERATIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 07/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 LITTLE KITTEN AVE
MANHATTAN KS
66503
US

IV. Provider business mailing address

3024 SW WANAMAKER RD STE 300
TOPEKA KS
66614-4498
US

V. Phone/Fax

Practice location:
  • Phone: 785-776-0065
  • Fax: 785-776-6825
Mailing address:
  • Phone: 785-272-1535
  • Fax: 785-440-0380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number175191
License Number StateKS

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier100108330A
Identifier TypeMEDICAID
Identifier StateKS
Identifier Issuer

VIII. Authorized Official

Name: MR. MICHAEL D TRYON
Title or Position: CFO
Credential:
Phone: 785-272-1535