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General NPI Number Information
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NPI Number | 1326224361
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Entity Type | Organization
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Legal Business Name | LIFECARE CENTER OF WICHITA
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Dates
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Enumeration Date | 01/20/2008
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Last Update Date | 01/20/2008
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Provider Practice Location Address
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Address Line | 622 N EDGEMOOR ST
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City | WICHITA
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State | KS
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Zip | 67208-3602
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Country | US
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Telephone | 316-686-5100
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Fax |
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Provider Business Mailing Address
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Address Line | 622 N EDGEMOOR ST
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City | WICHITA
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State | KS
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Zip | 67208-3602
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Country | US
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Telephone | 316-686-5100
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. BONNIE JACKSON
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Credential | R.N.
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Telephone | 316-686-5100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 17-02172
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License Number State | KS
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