Healthcare Provider Details

I. General information

NPI: 1598762189
Provider Name (Legal Business Name): INFINIA AT SMITH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 06/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 W 1ST ST
SMITH CENTER KS
66967-2005
US

IV. Provider business mailing address

PO BOX 369
SMITH CENTER KS
66967-0369
US

V. Phone/Fax

Practice location:
  • Phone: 785-282-6696
  • Fax: 785-282-3895
Mailing address:
  • Phone: 785-282-6696
  • Fax: 785-282-3895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberN-092-001
License Number StateKS

VIII. Authorized Official

Name: JON ROBERTSON
Title or Position: OWNER
Credential:
Phone: 801-296-5105