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General NPI Number Information
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NPI Number | 1124943592
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Entity Type | Individual
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Provider Name | MR. CELESTINE FOMEZA FOTECK
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Gender | Male
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Dates
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Enumeration Date | 08/12/2026
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Last Update Date | 08/12/2026
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Provider Practice Location Address
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Address Line | 5353 N TOBEN CT
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City | BEL AIRE
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State | KS
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Zip | 67226-8846
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Country | US
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Telephone | 316-932-3615
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Fax |
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Provider Business Mailing Address
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Address Line | 5353 N TOBEN CT
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City | BEL AIRE
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State | KS
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Zip | 67226-8846
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Country | US
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Telephone | 316-932-3615
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | B087134
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License Number State | KS
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