=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083706097
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JEWEL HEALTHCARE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/28/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 221 W LOGAN AVE
-----------------------------------------------------
City | EMPORIA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66801-4661
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 620-342-4212
-----------------------------------------------------
Fax | 620-342-6523
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 860665
-----------------------------------------------------
City | SHAWNEE
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66286-0665
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 913-631-0190
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. JEFFREY K PHILLIPS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 913-568-5220
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number | N056002
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------