=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053693374
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CARITAS CENTER, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/13/2011
-----------------------------------------------------
Last Update Date | 02/10/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1400 S SHERIDAN
-----------------------------------------------------
City | WICHITA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67213-1336
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-942-2201
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1400 S SHERIDAN ST
-----------------------------------------------------
City | WICHITA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67213-1336
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-942-2201
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP OF FINANCE & TECHNOLOGY
-----------------------------------------------------
Name | MR. WILLIAM SLATER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 316-946-5215
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------