Healthcare Provider Details

I. General information

NPI: 1245030865
Provider Name (Legal Business Name): BKD CLARE BRIDGE OF WICHITA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2025
Last Update Date: 03/13/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9191 E 21ST ST N
WICHITA KS
67206-2923
US

IV. Provider business mailing address

9191 E 21ST ST N
WICHITA KS
67206-2923
US

V. Phone/Fax

Practice location:
  • Phone: 316-630-0788
  • Fax:
Mailing address:
  • Phone: 316-630-0788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: ANNA F.C. MUNOZ
Title or Position: ASSISTANT SECRETARY
Credential:
Phone: 414-918-5443