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General NPI Number Information
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NPI Number | 1104543339
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Entity Type | Organization
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Legal Business Name | PLATINUM CARE HOMES LLC
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Dates
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Enumeration Date | 10/27/2022
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Last Update Date | 10/27/2022
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Provider Practice Location Address
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Address Line | 5701 E 17TH ST N
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City | WICHITA
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State | KS
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Zip | 67208-1703
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Country | US
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Telephone | 316-807-6761
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Fax | 316-239-7821
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Provider Business Mailing Address
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Address Line | 5701 E 17TH ST N
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City | WICHITA
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State | KS
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Zip | 67208-1703
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Country | US
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Telephone | 316-807-6761
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Fax | 316-239-7821
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Authorized Official
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Title or Position | OPERATOR
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Name | PAULA DENISE MACK
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Credential | OWNER
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Telephone | 316-807-6761
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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