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General NPI Number Information
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NPI Number | 1396438958
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Entity Type | Organization
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Legal Business Name | WHEAT HAVEN HOME LLC
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Dates
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Enumeration Date | 05/31/2023
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Last Update Date | 05/31/2023
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Provider Practice Location Address
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Address Line | 304 MARION ST
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City | MCDONALD
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State | KS
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Zip | 67745
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Country | US
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Telephone | 785-230-0244
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 87
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City | MC DONALD
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State | KS
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Zip | 67745-0087
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Country | US
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Telephone | 785-899-9009
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Fax | 785-414-5055
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Authorized Official
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Title or Position | MEMBER
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Name | BRADLEY PORUBSKY
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Credential |
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Telephone | 785-230-0244
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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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