Healthcare Provider Details

I. General information

NPI: 1720011901
Provider Name (Legal Business Name): MARKLEYSBURG HEALTHCARE INVESTORS, L.P.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 02/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 W 7TH ST
WELLSVILLE KS
66092-7800
US

IV. Provider business mailing address

304 W 7TH ST
WELLSVILLE KS
66092-7800
US

V. Phone/Fax

Practice location:
  • Phone: 785-883-4101
  • Fax: 785-883-2200
Mailing address:
  • Phone: 785-883-4101
  • Fax: 785-883-2200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberN030004
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number651
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number651
License Number StateGA

VIII. Authorized Official

Name: DOUGLAS K MITTLEIDER
Title or Position: PRESIDENT
Credential:
Phone: 770-619-0866