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General NPI Number Information
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NPI Number | 1346576311
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Entity Type | Organization
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Legal Business Name | SOUTHERN HOSPITALITY HOME
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Dates
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Enumeration Date | 10/27/2009
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Last Update Date | 10/27/2009
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Provider Practice Location Address
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Address Line | 20687 W 125TH CT
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City | OLATHE
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State | KS
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Zip | 66061-7822
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Country | US
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Telephone | 913-839-2827
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Fax | 913-839-2827
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Provider Business Mailing Address
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Address Line | 20687 W 125TH CT
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City | OLATHE
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State | KS
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Zip | 66061-7822
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Country | US
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Telephone | 913-839-2827
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Fax | 913-839-2827
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Authorized Official
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Title or Position | OWNER OPERATOR
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Name | MRS. MARY D MURRY
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Credential |
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Telephone | 913-839-2827
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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 | B046041
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License Number State | KS
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