Healthcare Provider Details

I. General information

NPI: 1194836163
Provider Name (Legal Business Name): CITY OF STOCKTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 09/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 S ASH ST
STOCKTON KS
67669-2136
US

IV. Provider business mailing address

315 S ASH ST
STOCKTON KS
67669-2136
US

V. Phone/Fax

Practice location:
  • Phone: 785-425-6754
  • Fax: 785-425-6755
Mailing address:
  • Phone: 785-425-6754
  • Fax: 785-425-6755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License NumberN082002
License Number StateKS

VIII. Authorized Official

Name: MR. KEITH SCHLAEGEL
Title or Position: CITY MANAGER
Credential:
Phone: 785-425-6703