Healthcare Provider Details

I. General information

NPI: 1205358959
Provider Name (Legal Business Name): WESTERN PRAIRIE NURSING FACILITY OPERATIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2017
Last Update Date: 07/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 E SAN JACINTO AVE
ULYSSES KS
67880
US

IV. Provider business mailing address

3024 SW WANAMAKER RD STE 300
TOPEKA KS
66614-4498
US

V. Phone/Fax

Practice location:
  • Phone: 620-356-3331
  • Fax: 620-356-1932
Mailing address:
  • Phone: 785-272-1535
  • Fax: 785-272-1480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL D TRYON
Title or Position: CFO
Credential:
Phone: 785-272-1535