Healthcare Provider Details

I. General information

NPI: 1265179022
Provider Name (Legal Business Name): MI CASA CARE HOMES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2022
Last Update Date: 03/10/2023
Certification Date: 03/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 MAIN ST
TOWANDA KS
67144-9001
US

IV. Provider business mailing address

1999 N AMIDON AVE STE 375
WICHITA KS
67203-2124
US

V. Phone/Fax

Practice location:
  • Phone: 316-777-6655
  • Fax: 888-975-7964
Mailing address:
  • Phone: 316-777-6655
  • Fax: 888-975-7964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number
License Number State

VIII. Authorized Official

Name: MONICA MORALES
Title or Position: OWNER
Credential: APRN
Phone: 316-777-6655