Healthcare Provider Details

I. General information

NPI: 1710971858
Provider Name (Legal Business Name): OTTAWA RETIREMENT PLAZA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2005
Last Update Date: 04/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1042 W 15TH ST
OTTAWA KS
66067-3951
US

IV. Provider business mailing address

330 STRAIGHT ST SUITE 330
CINCINNATI OH
45219-1064
US

V. Phone/Fax

Practice location:
  • Phone: 785-242-1127
  • Fax: 785-242-1536
Mailing address:
  • Phone: 513-487-3600
  • Fax: 513-487-3612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberNO3006
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License NumberNO3006
License Number StateKS
# 3
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberNO3006
License Number StateKS
# 4
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberNO3006
License Number StateKS
# 5
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License NumberNO3006
License Number StateKS

VIII. Authorized Official

Name: KENNETH F RAUPACH
Title or Position: COO
Credential:
Phone: 513-487-3600