Healthcare Provider Details

I. General information

NPI: 1780164517
Provider Name (Legal Business Name): SEDALIA HEALTH GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2018
Last Update Date: 08/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25023 BOTHWELL PARK RD
SEDALIA MO
65301-0084
US

IV. Provider business mailing address

11701 NIEMAN RD
OVERLAND PARK KS
66210-4310
US

V. Phone/Fax

Practice location:
  • Phone: 816-550-6418
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: NORMAN WILCOX
Title or Position: CEO
Credential:
Phone: 913-548-8559