Healthcare Provider Details

I. General information

NPI: 1437966967
Provider Name (Legal Business Name): 500 HEARTLAND PARK DR NE OPCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2024
Last Update Date: 12/18/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 HEARTLAND PARK DR
SEWARD NE
68434-1086
US

IV. Provider business mailing address

333 S BROADWAY AVE
WICHITA KS
67202-4300
US

V. Phone/Fax

Practice location:
  • Phone: 316-239-6662
  • Fax:
Mailing address:
  • Phone: 316-239-6662
  • 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: LAURA GAMBLE
Title or Position: SENIOR ACCOUNT MANAGER
Credential:
Phone: 316-239-6662