Healthcare Provider Details

I. General information

NPI: 1750334512
Provider Name (Legal Business Name): SATANTA DISTRICT HOSPITAL AND LONG-TERM CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 08/29/2025
Certification Date: 08/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 CHEYENNE STREET
SATANTA KS
67870-0159
US

IV. Provider business mailing address

PO BOX 159
SATANTA KS
67870-0159
US

V. Phone/Fax

Practice location:
  • Phone: 620-649-2761
  • Fax: 620-649-2776
Mailing address:
  • Phone: 620-649-2761
  • Fax: 620-649-2776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1040568501
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number1040568501
License Number StateKS

VII. Legacy identifiers

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

# 1
Identifier100107120A
Identifier TypeMEDICAID
Identifier StateKS
Identifier Issuer
# 2
Identifier1040568501
Identifier TypeOTHER
Identifier StateKS
Identifier IssuerSTATE PROVIDER #
# 3
Identifier17E356
Identifier TypeOTHER
Identifier StateKS
Identifier IssuerFEDERAL PROVIDER #
# 4
IdentifierH041001
Identifier TypeOTHER
Identifier StateKS
Identifier IssuerSTATE LICENSE FOR HOSPITA

VIII. Authorized Official

Name: TINA PENDERGRAFT
Title or Position: ADMINISTRATOR
Credential:
Phone: 620-649-2761