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General NPI Number Information
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NPI Number | 1366502197
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Entity Type | Organization
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Legal Business Name | MIDWEST HOMESTEAD OF LEAVENWORTH OPERATIONS, LLC
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Dates
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Enumeration Date | 12/11/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5150 HUGHES RD
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City | LEAVENWORTH
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State | KS
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Zip | 66048-4973
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Country | US
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Telephone | 913-727-9600
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Fax | 913-727-9604
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Provider Business Mailing Address
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Address Line | 3715 SW 29TH ST
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City | TOPEKA
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State | KS
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Zip | 66614-2107
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Country | US
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Telephone | 785-272-1535
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Fax | 785-440-0380
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Authorized Official
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Title or Position | CFO
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Name | MR. MICHAEL D TRYON
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Credential |
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Telephone | 785-272-1535
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number |
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License Number State | KS
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