Healthcare Provider Details

I. General information

NPI: 1679991020
Provider Name (Legal Business Name): TITUS BRIDGE APARTMENTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2014
Last Update Date: 04/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3224 SW 29TH ST
TOPEKA KS
66614-2009
US

IV. Provider business mailing address

PO BOX 684
PERRY KS
66073-0684
US

V. Phone/Fax

Practice location:
  • Phone: 785-272-2601
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number13-72073
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number13-72073
License Number StateKS

VIII. Authorized Official

Name: JOHN COLEMAN
Title or Position: PRESIDENT
Credential:
Phone: 785-331-8782