Healthcare Provider Details

I. General information

NPI: 1740528025
Provider Name (Legal Business Name): TALLGRASS CREEK, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2013
Last Update Date: 12/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13800 METCALF AVE ATTN: EXECUTIVE DIRECTOR
OVERLAND PARK KS
66223-1200
US

IV. Provider business mailing address

13800 METCALF AVE ATTN: EXECUTIVE DIRECTOR
OVERLAND PARK KS
66223-1200
US

V. Phone/Fax

Practice location:
  • Phone: 913-897-2700
  • Fax: 410-204-7237
Mailing address:
  • Phone: 913-897-2700
  • Fax: 410-204-7237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberN046088
License Number StateKS

VII. Legacy identifiers

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

VIII. Authorized Official

Name: CHRISTOPHER J RATHMANN
Title or Position: ASST TREASURER
Credential:
Phone: 410-402-2390